MEDICARE: MARK C DILLON MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0100X	Gastroenterology Physician	ME63710	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	100013898	OTHER	FL	RR MEDICARE
3	MM198	OTHER	FL	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013908920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK C DILLON MD

Provider Business Mailing Address
First Line	:	3300 S FISKE BLVD
Second Line	:
City	:	ROCKLEDGE
State	:	FL
Zip	:	32955-4306
Country	:	US
Telephone Number	:	321-434-8423
Fax Number	:

Provider Business Practice Location Address
First Line	:	1421 MALABAR RD NE STE 201
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32907-2559
Country	:	US
Telephone Number	:	321-434-8423
Fax Number	:	321-434-8148

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2005
Last Update Date	:	12/05/2023

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Directions to “ MARK C DILLON MD” Practice Location

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