Healthcare Provider Details

I. General information

NPI: 1720168826
Provider Name (Legal Business Name): MARK ANTONY LAPORTA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 04/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13305 ROSELAND ROAD #456 MARK ANTONY LAPORTA MD FACP LOCUMS NOT PATIENTS
ROSELAND FL
32957-0456
US

IV. Provider business mailing address

PO BOX 456
ROSELAND FL
32957-0456
US

V. Phone/Fax

Practice location:
  • Phone: 772-388-9595
  • Fax:
Mailing address:
  • Phone: 772-388-9595
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberFLME0041885
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME41885
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: