Provider Demographics
NPI:1063418028
Name:ALSON, MARK DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:ALSON
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 W FIR AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93611-0220
Mailing Address - Country:US
Mailing Address - Phone:559-297-0300
Mailing Address - Fax:559-323-5461
Practice Address - Street 1:231 W FIR AVE
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93611-0220
Practice Address - Country:US
Practice Address - Phone:559-297-0300
Practice Address - Fax:559-323-5461
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG731902085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G731900Medicaid
CA00G731900Medicare ID - Type Unspecified
CA00G731900Medicaid
CA00G731904Medicare PIN
CA00G731902Medicare PIN