Provider Demographics
NPI:1043213051
Name:GOROVOY, MARK S (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:S
Last Name:GOROVOY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:12381 S CLEVELAND AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-3852
Mailing Address - Country:US
Mailing Address - Phone:239-939-1444
Mailing Address - Fax:239-936-7710
Practice Address - Street 1:12381 S CLEVELAND AVE STE 300
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3852
Practice Address - Country:US
Practice Address - Phone:239-939-1444
Practice Address - Fax:239-936-7710
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2020-09-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME39771207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0868210-002OtherCIGNA
FL36319OtherBC/BS
FL805595OtherUNITED HEALTHCARE
FLP00117729OtherRR MEDICARE
FL15808OtherSTAYWELL
FL066657200Medicaid
FL4209944OtherAETNA
FL0868210-002OtherCIGNA
FLD54472Medicare UPIN