Provider Demographics
NPI:1568469013
Name:POMPER, MARK ELLIOT (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:ELLIOT
Last Name:POMPER
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:P.O. BOX 2277
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2277
Mailing Address - Country:US
Mailing Address - Phone:954-730-0233
Mailing Address - Fax:
Practice Address - Street 1:1036 NW 1ST AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4417
Practice Address - Country:US
Practice Address - Phone:954-730-2333
Practice Address - Fax:954-730-2337
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME553622085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL053765900Medicaid
FLE84317Medicare UPIN
FL12231Medicare PIN