Provider Demographics
NPI:1588725006
Name:MARK, TIMOTHY (MD)
Entity type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:
Last Name:MARK
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 1:2801 N FLAGLER DR
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-5215
Mailing Address - Country:US
Mailing Address - Phone:561-659-7411
Mailing Address - Fax:561-659-7423
Practice Address - Street 1:2801 N FLAGLER DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-5215
Practice Address - Country:US
Practice Address - Phone:561-659-7411
Practice Address - Fax:561-659-7423
Is Sole Proprietor?:No
Enumeration Date:2006-12-12
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME77634207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME77634OtherSTATE ID
FL591199726OtherTAX ID
FL374191500Medicaid
FL374191500Medicaid
FL374191500Medicaid
FLH2127Medicare UPIN