Healthcare Provider Details

I. General information

NPI: 1952735219
Provider Name (Legal Business Name): MARK A. DREYER DPM, FACAFAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2013
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11505 RANGELAND PKWY
BRADENTON FL
34211-4041
US

IV. Provider business mailing address

11505 RANGELAND PKWY
BRADENTON FL
34211-4041
US

V. Phone/Fax

Practice location:
  • Phone: 941-362-8662
  • Fax: 941-362-8602
Mailing address:
  • Phone: 941-362-8662
  • Fax: 941-362-8602

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number00347
License Number StateRI
# 2
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number00347
License Number StateRI
# 3
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO4081
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: