Healthcare Provider Details

I. General information

NPI: 1275521221
Provider Name (Legal Business Name): MARK ALLEN RINER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 12/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1893 N CLYDE MORRIS BLVD SUITE 100
DAYTONA BEACH FL
32117-5535
US

IV. Provider business mailing address

1893 N CLYDE MORRIS BLVD SUITE 100
DAYTONA BEACH FL
32117-5535
US

V. Phone/Fax

Practice location:
  • Phone: 386-677-0531
  • Fax: 386-672-7515
Mailing address:
  • Phone: 386-677-0531
  • Fax: 386-672-7515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberME 50466
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: