Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | ME20357 | FL |
Y | 111NI0900X | Internist | ME20357 | FL |
N | 207RN0300X | Nephrologist | ME20357 | FL |
NPI | 1033181177 |
---|---|
Provider Name | Donald R. Mars |
First Address | Jacksonville, FL 32231-4004 |
Second Address | Jacksonville, FL 32207-8205 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/02/2006 |
Last Update Date | 18/11/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2662680-00 | (05) | FL |
D57788 | (02) | |
P00267350 | RR MEDICARE (01) | FL |