Provider Demographics
NPI:1962605261
Name:PRYSI, MARK FRANKLIN (MD)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:FRANKLIN
Last Name:PRYSI
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 1:9125 CORSEA DEL FONTANA WAY
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34109-4396
Mailing Address - Country:US
Mailing Address - Phone:239-643-3223
Mailing Address - Fax:239-430-2007
Practice Address - Street 1:9125 CORSEA DEL FONTANA WAY
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34109-4396
Practice Address - Country:US
Practice Address - Phone:239-643-3223
Practice Address - Fax:239-430-2007
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 54804174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist