Provider Demographics
NPI:1194810952
Name:SOCKELL, MARK ELLIOT (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ELLIOT
Last Name:SOCKELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1952 CENTRO WEST ST
Mailing Address - Street 2:
Mailing Address - City:TIBURON
Mailing Address - State:CA
Mailing Address - Zip Code:94920
Mailing Address - Country:US
Mailing Address - Phone:650-302-0394
Mailing Address - Fax:856-341-7808
Practice Address - Street 1:WEST MARIN MEDICAL CENTER
Practice Address - Street 2:11150 STATE ROUTE 1
Practice Address - City:POINT REYERS
Practice Address - State:CA
Practice Address - Zip Code:94956
Practice Address - Country:US
Practice Address - Phone:415-663-1082
Practice Address - Fax:415-663-9474
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2022-09-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG53283207R00000X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G532830Medicaid
CA00G532830Medicare ID - Type UnspecifiedMEDICARE NUMBER
CA00G532830Medicaid