Provider Demographics
NPI:1093898397
Name:CORRY, MARK LANGE (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:LANGE
Last Name:CORRY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7593 W BOYNTON BEACH BLVD STE 220
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33437-6162
Mailing Address - Country:US
Mailing Address - Phone:561-678-2652
Mailing Address - Fax:561-743-3667
Practice Address - Street 1:169 TEQUESTA DR STE 12E
Practice Address - Street 2:
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33469-2783
Practice Address - Country:US
Practice Address - Phone:561-747-7672
Practice Address - Fax:561-743-3667
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2023-09-18
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Provider Licenses
StateLicense IDTaxonomies
FLME78193207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G96517Medicare UPIN
FL467182Medicare ID - Type Unspecified