Provider Demographics
NPI:1386737179
Name:MARK V. GARBUTT, MD PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:MARK V. GARBUTT, MD PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GARBUTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:620-629-7713
Mailing Address - Street 1:230 PROSPECT PL STE 310
Mailing Address - Street 2:
Mailing Address - City:CORONADO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-1988
Mailing Address - Country:US
Mailing Address - Phone:620-629-7713
Mailing Address - Fax:
Practice Address - Street 1:230 PROSPECT PL STE 310
Practice Address - Street 2:
Practice Address - City:CORONADO
Practice Address - State:CA
Practice Address - Zip Code:92118-1988
Practice Address - Country:US
Practice Address - Phone:620-629-7713
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty