Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | A43400 | CA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | A43400 | CA |
NPI | 1083657654 |
---|---|
Provider Name | Dr. Mark E. Schakel II |
First Address | Santa Rosa, CA 95405-4557 |
Second Address | Santa Rosa, CA 95405-4557 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/06/2006 |
Last Update Date | 04/12/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A434000 | (05) | CA |
A29687 | (02) | |
A43400 | STATE LICENSE (01) | CA |