Healthcare Provider Details

I. General information

NPI: 1881633402
Provider Name (Legal Business Name): MARK ALLEN CASEBOLT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 01/22/2021
Certification Date: 01/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 SW 1ST AVE STE 105
OCALA FL
34471-6506
US

IV. Provider business mailing address

1541 SW 1ST AVE SUITE 105
OCALA FL
34471
US

V. Phone/Fax

Practice location:
  • Phone: 352-622-8152
  • Fax: 352-622-4408
Mailing address:
  • Phone: 352-622-8152
  • Fax: 352-622-4408

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME109242
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: