Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0122X | Plastic and Reconstructive Surgery | G65132 | CA |
NPI | 1326102260 |
---|---|
Provider Name | Dr. Mark A. Anton |
First Address | Newport Beach, CA 92663-3522 |
Second Address | Newport Beach, CA 92663-3522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E54472 | (02) | CA |