Provider Demographics
NPI:1720065451
Name:JASMINE, MARK SCOTT (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:SCOTT
Last Name:JASMINE
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:PO BOX 1606
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NC
Mailing Address - Zip Code:28026-6002
Mailing Address - Country:US
Mailing Address - Phone:704-788-3155
Mailing Address - Fax:704-785-8302
Practice Address - Street 1:354 COPPERFIELD BLVD NE
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:NC
Practice Address - Zip Code:28025-2402
Practice Address - Country:US
Practice Address - Phone:704-788-3155
Practice Address - Fax:704-785-8302
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28052207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Not Answered207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4066545OtherAETNA HMO PPO
22924OtherPARTNERS MEDICARE
25928OtherMEDCOST
45845OtherBCBS OF NC
0941048OtherUNITED HEALTHCARE
140895OtherONE HEALTH PLAN
0825076004OtherCIGNA HEALTHCARE
2069463OtherAETNA US HEALTHCARE
530004OtherPRINCIPAL HEALTHCARE
45845OtherBCBS OF NC
2069463OtherAETNA US HEALTHCARE