Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 07-1003 | AZ |
NPI | 1063888139 |
---|---|
Provider Name | Dr. Mark D. Tenborg |
First Address | Gold Canyon, AZ 85118-6845 |
Second Address | Gold Canyon, AZ 85118-6845 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2015 |
Last Update Date | 12/08/2015 |