Provider Demographics
NPI:1104133438
Name:ASHBAKER, MARK DUANE
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:DUANE
Last Name:ASHBAKER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28665 HIGHWAY AB
Mailing Address - Street 2:
Mailing Address - City:RICHLAND
Mailing Address - State:MO
Mailing Address - Zip Code:65556-7463
Mailing Address - Country:US
Mailing Address - Phone:757-525-0501
Mailing Address - Fax:
Practice Address - Street 1:126 MISSOURI AVENUE
Practice Address - Street 2:
Practice Address - City:FT LEONARD WOOD
Practice Address - State:MO
Practice Address - Zip Code:65473
Practice Address - Country:US
Practice Address - Phone:573-596-0048
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156F00000XEye and Vision Services ProvidersTechnician/Technologist