Provider Demographics
NPI:1962740142
Name:LAUVER, MARK
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:LAUVER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:502 S FREMONT AVE APT 1042
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-4310
Mailing Address - Country:US
Mailing Address - Phone:813-490-5490
Mailing Address - Fax:
Practice Address - Street 1:502 S FREMONT AVE APT 1042
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-4310
Practice Address - Country:US
Practice Address - Phone:813-490-5490
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-23
Last Update Date:2013-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator