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General NPI Number Information
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NPI Number | 1235326844
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Entity Type | Organization
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Legal Business Name | MARKUS SONNTAG MD
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Dates
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Enumeration Date | 09/27/2007
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Last Update Date | 09/27/2007
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Provider Practice Location Address
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Address Line | 2035 PROFESSIONAL CENTER DR STE C
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City | ORANGE PARK
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State | FL
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Zip | 32073-4462
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Country | US
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Telephone | 904-272-0384
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Fax | 904-272-6748
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Provider Business Mailing Address
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Address Line | 2035 PROFESSIONAL CENTER DR STE C
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City | ORANGE PARK
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State | FL
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Zip | 32073-4462
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Country | US
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Telephone | 904-272-0384
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Fax | 904-272-6748
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Authorized Official
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Title or Position | OWNER
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Name | MARKUS SONNTAG
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Credential | MD
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Telephone | 904-272-0384
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME92805
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License Number State | FL
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