Provider Demographics
NPI:1386618932
Name:YACHT, MARC J (MD)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:J
Last Name:YACHT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18137 BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-5839
Mailing Address - Country:US
Mailing Address - Phone:727-862-8203
Mailing Address - Fax:
Practice Address - Street 1:18137 BRANCH RD
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-5839
Practice Address - Country:US
Practice Address - Phone:727-862-8203
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME41785208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL042098100Medicaid
FL96169OtherBLUE CROSS BLUE SHIELD
FL96169ZMedicare ID - Type Unspecified
FL042098100Medicaid