Healthcare Provider Details

I. General information

NPI: 1073510608
Provider Name (Legal Business Name): MARK J SIGMAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 02/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

844 N THORNTON AVE
ORLANDO FL
32803-4003
US

IV. Provider business mailing address

844 NORTH THORNTON AVENUE
ORLANDO FL
32803-4003
US

V. Phone/Fax

Practice location:
  • Phone: 407-398-6470
  • Fax: 407-894-6872
Mailing address:
  • Phone: 407-398-6470
  • Fax: 407-894-6872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD073400L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME109698
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: