Basic Information
| Provider Information | |||||||||
| NPI: | 1598767543 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | NORES | ||||||||
| FirstName: | MARCOS | ||||||||
| MiddleName: | AGUSTIN | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5301 SOUTH CONGRESS AVE. SUITE 300 | ||||||||
| Address2: | |||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33462 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615484900 | ||||||||
| FaxNumber: | 5615484902 | ||||||||
| Practice Location | |||||||||
| Address1: | 5301 S CONGRESS AVE | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | ATLANTIS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334621149 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5615484900 | ||||||||
| FaxNumber: | 5615484900 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2005 | ||||||||
| LastUpdateDate: | 06/26/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208G00000X | ME108415 | FL | Y | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) |
ID Information
| ID | Type | State | Issuer | Description | 64074255 | 05 | KY | MEDICAID | 003918300 | 05 | FL | MEDICAID | CJ6802 | 01 | KY | PALMETTO | OTHER |