Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 35095661 | OH |
Y | 207X00000X | Orthopaedic Surgeon | ME134460 | FL |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 35095661 | OH |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | ME134460 | FL |
NPI | 1104077064 |
---|---|
Provider Name | Dr. Mark Richard Zunkiewicz |
First Address | Daytona Beach, FL 32117-5169 |
Second Address | Daytona Beach, FL 32117-5169 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/10/2008 |
Last Update Date | 19/08/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
3071143 | (05) | OH |
35095661 | STATE LICENSE (01) | OH |
FZ0752332 | DEA (01) | OH |