Provider Demographics
NPI:1063888139
Name:TENBORG, MARK D (NMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:TENBORG
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:DR
Other - First Name:MARK
Other - Middle Name:D
Other - Last Name:TENBORG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:NMD,
Mailing Address - Street 1:9967 E FORTUNA AVE
Mailing Address - Street 2:
Mailing Address - City:GOLD CANYON
Mailing Address - State:AZ
Mailing Address - Zip Code:85118-6845
Mailing Address - Country:US
Mailing Address - Phone:480-983-2694
Mailing Address - Fax:
Practice Address - Street 1:9967 E FORTUNA AVE
Practice Address - Street 2:
Practice Address - City:GOLD CANYON
Practice Address - State:AZ
Practice Address - Zip Code:85118-6845
Practice Address - Country:US
Practice Address - Phone:480-983-2694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ07-1003175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath