Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1104133438 |
---|---|
Provider Name | Mr. Mark Duane Ashbaker |
First Address | Richland, MO 65556-7463 |
Second Address | Ft Leonard Wood, MO 65473 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/09/2010 |
Last Update Date | 08/09/2010 |