Provider Demographics
NPI:1609832591
Name:EFIRD, MARK ALEXANDER (PA)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ALEXANDER
Last Name:EFIRD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:117 WINDSONG CT
Mailing Address - Street 2:
Mailing Address - City:GASTONIA
Mailing Address - State:NC
Mailing Address - Zip Code:28056-8897
Mailing Address - Country:US
Mailing Address - Phone:704-865-7096
Mailing Address - Fax:704-853-3735
Practice Address - Street 1:311 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:GASTONIA
Practice Address - State:NC
Practice Address - Zip Code:28052-4057
Practice Address - Country:US
Practice Address - Phone:704-865-7096
Practice Address - Fax:704-853-3735
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC102009363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC523005Medicare UPIN
NC2799766Medicare ID - Type UnspecifiedPROVIDER NUMBER