Healthcare Provider Details

I. General information

NPI: 1265471742
Provider Name (Legal Business Name): MARK M KARAS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 10/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

195 SOUTHPARK BLVD VA ST AUGUSTINE CBOC
ST AUGUSTINE FL
32086-5134
US

IV. Provider business mailing address

195 SOUTHPARK BLVD VA ST AUGUSTINE CBOC
ST AUGUSTINE FL
32086-5134
US

V. Phone/Fax

Practice location:
  • Phone: 904-823-2961
  • Fax: 904-824-1165
Mailing address:
  • Phone: 904-823-2961
  • Fax: 904-824-1165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD019473E
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: