Provider Demographics
NPI:1992135693
Name:VALLIERE, MARK (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:VALLIERE
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 1:701 10TH ST. SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-9989
Mailing Address - Country:US
Mailing Address - Phone:319-398-6440
Mailing Address - Fax:319-398-6912
Practice Address - Street 1:947 14TH AVE. SE
Practice Address - Street 2:COMMUNITY HEALTH FREE CLINIC
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401
Practice Address - Country:US
Practice Address - Phone:319-363-0416
Practice Address - Fax:319-363-5569
Is Sole Proprietor?:No
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24547207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine