Provider Demographics
NPI:1073647707
Name:BIVINS, MARC HUGH (MD)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:HUGH
Last Name:BIVINS
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:304 INDIAN TRCE
Mailing Address - Street 2:SUITE 167
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-2996
Mailing Address - Country:US
Mailing Address - Phone:904-281-0944
Mailing Address - Fax:904-281-9806
Practice Address - Street 1:9711 W OAKLAND PARK BLVD
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33351-7013
Practice Address - Country:US
Practice Address - Phone:904-281-0944
Practice Address - Fax:904-281-9806
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2013-09-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME52294207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL259948100Medicaid
FLG50074Medicare UPIN
FL259948100Medicaid