Provider Demographics
NPI:1588693105
Name:BACKUS, MARK A (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:BACKUS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2239 NE DOCTORS DR
Mailing Address - Street 2:STE 200
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7185
Mailing Address - Country:US
Mailing Address - Phone:541-318-0124
Mailing Address - Fax:541-318-0182
Practice Address - Street 1:2239 NE DOCTORS DR STE 200
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7185
Practice Address - Country:US
Practice Address - Phone:541-318-0124
Practice Address - Fax:541-318-0188
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD22701207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR288094Medicaid
ORG14452Medicare UPIN
OR107644Medicare ID - Type Unspecified