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General NPI Number Information
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NPI Number | 1265789705
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Entity Type | Organization
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Legal Business Name | MITCHELL MARKS MEDICIAL DECISION ASSOCIATES P A
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Dates
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Enumeration Date | 08/14/2012
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Last Update Date | 10/19/2012
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Provider Practice Location Address
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Address Line | 3345 BURNS RD SUITE 101
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-4324
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Country | US
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Telephone | 561-622-2022
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Fax | 561-622-6775
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Provider Business Mailing Address
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Address Line | 3345 BURNS RD SUITE 101
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City | PALM BEACH GARDENS
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State | FL
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Zip | 33410-4324
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Country | US
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Telephone | 561-622-2022
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Fax | 561-622-6775
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | DR. MITCHELL L MARKS
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Credential | D.O.
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Telephone | 561-622-2022
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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 | OS5567
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License Number State | FL
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