Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208G00000X | Cardiothoracic Vascular Surgeon | ME70190 | FL |
NPI | 1043212269 |
---|---|
Provider Name | Dr. Mark A Mostovych |
First Address | Jacksonville, FL 32204-4735 |
Second Address | Jacksonville, FL 32204-4735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/06/2005 |
Last Update Date | 05/09/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
250218600 | (05) | FL |
780000717 | MEDICARE RAILROAD (01) | |
F96911 | (02) | FL |