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Mark Todd Roback, DO
General Practice Physician in Fortuna, California
NPI 1801969829

Mark Todd Roback is a General Practice Physician based in Arcata, CA. Mark Todd Roback practices in Fortuna, CA and has the professional credentials of DO. The NPI Number for Mark Todd Roback is 1801969829 and holds a License No. R1153 (California).

The current practice location address for Mark Todd Roback is 3304 Renner Dr, Fortuna, CA and can be reached out via phone at 707-725-4477 and via fax at 707-725-9209.

Location: 3304 Renner Dr, Fortuna, CA, 95521-6249
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1801969829
Provider Name
Mark Todd Roback
Credential
DO
Provider Entity Type
Individual
Gender
Male
Address
3304 Renner Dr, Fortuna, CA, 95521-6249
Phone Number
707-725-4477
Fax Number
707-725-9209
Provider Enumeration Date
11/16/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
7100028230 05 KY
R1153 01 KY TEMP LICENSE
1801969829 01 CA NPI
institution
Provider Business Practice Location Address Details
Address
3304 Renner Dr
City
Fortuna
State
California
Zip
95540-7102
Phone Number
707-725-4477
Fax Number
707-725-9209
person
Provider Business Mailing Address Details
Address
3304 Renner Dr
City
Fortuna
State
California
Zip
95540-7102
Phone Number
707-725-4477
Fax Number
707-725-9209
person
Provider's Taxonomy Details 1
Type
Allopathic & Osteopathic Physicians
Classification
Family Medicine
Speciality
-
Taxonomy
207Q00000X
License No.
20A10324 (California)
Definition
Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity.
person
Provider's Taxonomy Details 2
Type
Allopathic & Osteopathic Physicians
Classification
General Practice
Speciality
-
Taxonomy
208D00000X
License No.
R1153 (Kentucky)
Definition
Definition to come...
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