Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | ME88114 | FL |
NPI | 1073527479 |
---|---|
Provider Name | Dr. Barry Jay Mark |
First Address | Miami, FL 33175-3584 |
Second Address | Aventura, FL 33180-1226 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/07/2006 |
Last Update Date | 21/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
276214500 | (05) | FL |