Healthcare Provider Details

I. General information

NPI: 1225034176
Provider Name (Legal Business Name): MARK STEWART BLOCK DPM PA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2005
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 GLADES RD STE 120
BOCA RATON FL
33431-6466
US

IV. Provider business mailing address

660 GLADES RD STE 120
BOCA RATON FL
33431-6466
US

V. Phone/Fax

Practice location:
  • Phone: 561-368-3232
  • Fax: 561-368-3234
Mailing address:
  • Phone: 561-368-3232
  • Fax: 561-368-3234

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0000X
TaxonomySports Medicine Podiatrist
License NumberPO1182
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO1182
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code213ES0131X
TaxonomyFoot Surgery Podiatrist
License NumberPO1182
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: