MEDICARE: DR. DAVID BRUCE MARK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	G35305	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912900218
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID BRUCE MARK M.D.

Provider Business Mailing Address
First Line	:	1010 W FREMONT AVE
Second Line	:	STE 200
City	:	SUNNYVALE
State	:	CA
Zip	:	94087-3019
Country	:	US
Telephone Number	:	408-739-6200
Fax Number	:	408-739-2439

Provider Business Practice Location Address
First Line	:	1010 W FREMONT AVE
Second Line	:	STE 200
City	:	SUNNYVALE
State	:	CA
Zip	:	94087-3019
Country	:	US
Telephone Number	:	408-739-6200
Fax Number	:	408-739-2439

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	01/31/2013

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