Basic Information
| Provider Information | |||||||||
| NPI: | 1821060658 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MARK | ||||||||
| FirstName: | THOMAS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3093 | ||||||||
| Address2: | |||||||||
| City: | BOCA RATON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334310993 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3055036320 | ||||||||
| FaxNumber: | 3055036329 | ||||||||
| Practice Location | |||||||||
| Address1: | 5000 UNIVERSITY DR | ||||||||
| Address2: | |||||||||
| City: | CORAL GABLES | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331462008 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3056693471 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2006 | ||||||||
| LastUpdateDate: | 09/17/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207ZC0500X | ME35872 | FL | N | Allopathic & Osteopathic Physicians | Pathology | Cytopathology | 207ZP0102X | ME35872 | FL | N | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology | 207ZP0105X | ME35872 | FL | Y | Allopathic & Osteopathic Physicians | Pathology | Clinical Pathology/Laboratory Medicine |
No ID Information.