Provider Demographics
NPI:1447278262
Name:GARCIA, MARK DAVID (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:DAVID
Last Name:GARCIA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7307 S YALE AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7134
Mailing Address - Country:US
Mailing Address - Phone:918-891-2303
Mailing Address - Fax:918-205-6349
Practice Address - Street 1:7307 S YALE AVE STE 101
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7134
Practice Address - Country:US
Practice Address - Phone:918-891-2303
Practice Address - Fax:918-205-6349
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6851207NS0135X
TXL9203207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXI15683Medicare UPIN