Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223E0200X | Endodontist | 39562 | CA |
NPI | 1134273592 |
---|---|
Provider Name | Dr. Mark Roper |
First Address | Petaluma, CA 94954-6965 |
Second Address | Petaluma, CA 94954-6965 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/01/2007 |
Last Update Date | 25/11/2008 |