Healthcare Provider Details

I. General information

NPI: 1750358099
Provider Name (Legal Business Name): MARK PERNI DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 05/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15100 RESCUE WAY
CLEARWATER FL
33762-3502
US

IV. Provider business mailing address

24740 ENERGY HWY
NEW MARTINSVILLE WV
26155-8570
US

V. Phone/Fax

Practice location:
  • Phone: 727-535-1437
  • Fax: 727-535-4190
Mailing address:
  • Phone: 912-659-1544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberOS008592L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: