Provider Demographics
NPI:1336313758
Name:MARK O. ASPERILLA M.D.P.A.
Entity type:Organization
Organization Name:MARK O. ASPERILLA M.D.P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:OLIVARES
Authorized Official - Last Name:ASPERILLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:941-624-4499
Mailing Address - Street 1:3300 TAMIAMI TRL
Mailing Address - Street 2:STE.102A
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33952-8054
Mailing Address - Country:US
Mailing Address - Phone:941-624-4499
Mailing Address - Fax:941-624-0212
Practice Address - Street 1:3300 TAMIAMI TRL
Practice Address - Street 2:STE.102A
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33952-8054
Practice Address - Country:US
Practice Address - Phone:941-624-4499
Practice Address - Fax:941-624-0212
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0052172207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10933OtherMEDICARE PTAN
FLE59531Medicare UPIN