Basic Information
| Provider Information | |||||||||
| NPI: | 1639239528 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARK J SONTAG MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 363 MAIN ST | ||||||||
| Address2: | C | ||||||||
| City: | REDWOOD CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940631729 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503069490 | ||||||||
| FaxNumber: | 6503060250 | ||||||||
| Practice Location | |||||||||
| Address1: | 363 MAIN STREET | ||||||||
| Address2: | C | ||||||||
| City: | REDWOOD CITY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94063 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503069490 | ||||||||
| FaxNumber: | 6503060250 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/11/2006 | ||||||||
| LastUpdateDate: | 02/01/2008 | ||||||||
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| AuthorizedOfficialLastName: | SONTAG | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | JORDAN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6503069490 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2081P2900X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
No ID Information.