Healthcare Provider Details

I. General information

NPI: 1144255530
Provider Name (Legal Business Name): MARK R DOSCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 06/23/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1325 S CONGRESS AVE SUITE 211
BOYNTON BEACH FL
33426
US

IV. Provider business mailing address

PO BOX 740177
BOYNTON BEACH FL
33474-0177
US

V. Phone/Fax

Practice location:
  • Phone: 561-732-2900
  • Fax: 561-734-9240
Mailing address:
  • Phone: 561-740-2900
  • Fax: 561-740-2901

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME48457
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: