Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mark Todd Roback, DO

Individual provider Family Medicine Physician · NPI 1801969829

Mark Todd Roback, DO is a Family Practice in Fortuna, California. Qualified in 2004, 22 years ago. Practices with Shasta Regional Medical Group Inc, a 34-clinician group and accepts Medicare assignment. Licensed in California and Kentucky.

Years since qualifying
22
Licensed in
CA, KY
In the registry since
2006
Specialties on file
2
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

3304 Renner Dr
Fortuna, CA 95540-7102
Phone: (707) 725-4477
Fax: (707) 725-9209
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

General Practice Physician (primary) Taxonomy 208D00000X · Licence 20A10324 (CA)
Family Medicine Physician Taxonomy 207Q00000X · Licence R1153 (KY)

Record details

NPI number1801969829
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorNo
NPI enumeratedNovember 16, 2006
Last updated in NPPESAugust 25, 2014
Mailing address670 9th Street, Suite 203, Arcata, CA 95521-6249

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2004 (22 years in practice)
Group practice Shasta Regional Medical Group Inc — 34 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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