Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | ME74593 | FL |
NPI | 1013993377 |
---|---|
Provider Name | Dr. Mark Sargent |
First Address | Viera, FL 32940-6230 |
Second Address | Viera, FL 32940-6230 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/12/2005 |
Last Update Date | 21/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
239793 | WELLCARE (01) | FL |
269307100 | (05) | FL |
3151723001 | CIGNA (01) | FL |
37841 | BLUE CROSS BLUE SHIELD (01) | FL |
7845531 | AETNA (01) | FL |
I13260 | (02) | FL |