Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 41520 | CA |
NPI | 1659399285 |
---|---|
Provider Name | Dr. Mark L Pledger |
First Address | Murrieta, CA 92562 |
Second Address | Murrieta, CA 92562 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0505697177 | TAX ID NUMBER (01) | CA |