Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 204483 | NY |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 204483 | NY |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 204483 | NY |
N | 207XX0801X | Orthopaedic Trauma Surgeon | 204483 | NY |
NPI | 1164443545 |
---|---|
Provider Name | Dr. James B Mark |
First Address | Geneva, NY 14456-1530 |
Second Address | Geneva, NY 14456-1530 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/07/2006 |
Last Update Date | 14/06/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
017355895 | (05) | NY |
G35127 | (02) |