Healthcare Provider Details

I. General information

NPI: 1255329009
Provider Name (Legal Business Name): MARK ANASTACIO YAP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2005
Last Update Date: 09/30/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 SW 15TH AVE
OCALA FL
34474-3548
US

IV. Provider business mailing address

PO BOX 6200
OCALA FL
34478-6200
US

V. Phone/Fax

Practice location:
  • Phone: 352-671-4300
  • Fax: 352-671-4393
Mailing address:
  • Phone: 352-671-4300
  • Fax: 352-671-4393

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME59370
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberME 59370
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: