Mark Mitchell Garskof, M.D.

Key facts

NPI

1568445211

Entity type

Individual (NPI type 1)

Primary specialty

Family Medicine Physician 207Q00000X

License

10885 (AZ)

Practice address

2963 W White Mountain Blvd
Lakeside, AZ 85929-6257

Phone

(928) 368-0765

Fax

(928) 368-4540

NPI assigned

Nov 28, 2005

Sex

Male

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

Yes

Credentials

Doctor of Medicine

State licenses

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 17, 2015.

{
    "created_epoch": "1133136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1426550400000",
    "number": "1568445211",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2963 W WHITE MOUNTAIN BLVD",
            "city": "LAKESIDE",
            "state": "AZ",
            "postal_code": "859296257",
            "telephone_number": "928-368-0765",
            "fax_number": "928-368-4540"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2963 W WHITE MOUNTAIN BLVD",
            "city": "LAKESIDE",
            "state": "AZ",
            "postal_code": "859296257",
            "telephone_number": "928-368-0765",
            "fax_number": "928-368-4540"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GARSKOF",
        "first_name": "MARK",
        "middle_name": "MITCHELL",
        "name_prefix": "Mr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-28",
        "last_updated": "2015-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "AZ",
            "license": "10885",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS",
            "identifier": "AZ0389120",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200262",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Lakeside, AZ · Family Medicine Physician in Arizona