Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | PO2975 | FL |
NPI | 1033172630 |
---|---|
Provider Name | Dr. Mark A Maederer JR. |
First Address | Miami, FL 33125-4241 |
Second Address | Miami, FL 33125 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/04/2006 |
Last Update Date | 28/08/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3406512 00 | (05) | FL |
65739Y | MEDICARE LEGACY (01) | FL |
U84571 | (02) | FL |