Provider Demographics
NPI:1487724936
Name:MEHLFERBER, MARK STEVEN (PAC)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:STEVEN
Last Name:MEHLFERBER
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17016
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:VA
Mailing Address - Zip Code:24209-7016
Mailing Address - Country:US
Mailing Address - Phone:423-844-6407
Mailing Address - Fax:866-285-5248
Practice Address - Street 1:320 BRISTOL WEST BLVD STE 2B
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-8765
Practice Address - Country:US
Practice Address - Phone:423-844-6407
Practice Address - Fax:866-285-5248
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNP14842363AM0700X
TNTNP14842363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Not Answered363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4107910OtherBC & BS SURGICAL
TNTN0103OtherJOHN DEERE
TN4107899OtherBC & BS MEDICAL
TN3661377Medicare ID - Type Unspecified
TNP14842Medicare UPIN