Mansfield, Mark L

Mansfield, Mark L is an sole proprietor health care provider with primary practice located at 110 Vista Dr , Pocatello ID 83201-5824. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Mansfield, Mark L can be contacted via phone (208) 234-2300.

Contact Information

Primary practice address
110 Vista Dr Pocatello ID 83201-5824
Phone: (208) 234-2300
Fax: (208) 234-0026
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X M-6799 Idaho

Profile Details

NPI number 1134113251
LBN Legal business name Mansfield, Mark L
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 Yes
Enumeration date Sep 2nd, 2005
Last updated Jan 7th, 2014 - about 10 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1134113251 NPPES
Idaho Other 000010000246 BLUE SHIELD PROVIDER NUMB
Idaho Other 080179524 BLUE SHIELD PROVIDER NUMB
Idaho Other DI726 BLUE SHIELD PROVIDER NUMB
Idaho MEDICAID 804222200 BLUE SHIELD PROVIDER NUMB

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