MEDICARE: MARK L PERMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	FLME59298	FL
2	2085R0001X	Radiation Oncology Physician	ME59298	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
6	P01572583	OTHER	FL	RR MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11781	OTHER	FL	BCBS
2	278876	OTHER	FL	AVMED
3	4335023	OTHER	FL	AETNA
4	11781	OTHER	FL	BLUE CROSS BLUE SHIELD
5	1613633	OTHER	FL	CIGNA
7	1249231	OTHER	FL	WELLCARE
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	P106954	OTHER	FL	FREEDOM
10	P938826	OTHER	FL	OPTIMUM
11	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1912982802
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK L PERMAN M.D.

Provider Business Mailing Address
First Line	:	2234 COLONIAL BLVD
Second Line	:	ATTN: PAYER CONTRACTING & RELATIONS DEPT.
City	:	FORT MYERS
State	:	FL
Zip	:	33907-1412
Country	:	US
Telephone Number	:	239-931-7342
Fax Number	:	239-931-7385

Provider Business Practice Location Address
First Line	:	2107 SE OCEAN BLVD
Second Line	:
City	:	STUART
State	:	FL
Zip	:	34996-3305
Country	:	US
Telephone Number	:	772-403-2390
Fax Number	:	772-403-2395

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/13/2005
Last Update Date	:	10/20/2016

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