Provider Demographics
NPI:1912391897
Name:JUHL, MARK (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:JUHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1661 LUCERNE ST
Mailing Address - Street 2:
Mailing Address - City:MINDEN
Mailing Address - State:NV
Mailing Address - Zip Code:89423-4381
Mailing Address - Country:US
Mailing Address - Phone:775-782-0700
Mailing Address - Fax:775-782-0500
Practice Address - Street 1:1661 LUCERNE ST
Practice Address - Street 2:
Practice Address - City:MINDEN
Practice Address - State:NV
Practice Address - Zip Code:89423-4381
Practice Address - Country:US
Practice Address - Phone:775-782-0700
Practice Address - Fax:775-782-0500
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-27
Last Update Date:2024-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA162860207N00000X, 207ND0101X, 207NS0135X
NV20876207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural DermatologyGroup - Single Specialty