Provider Demographics
NPI:1164609970
Name:DROSSNER, DAVID MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARK
Last Name:DROSSNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3100 SW 62ND AVE
Mailing Address - Street 2:PEDIATRIC CARDIOLOGY
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-3009
Mailing Address - Country:US
Mailing Address - Phone:305-662-8301
Mailing Address - Fax:305-662-8304
Practice Address - Street 1:3100 SW 62ND AVE
Practice Address - Street 2:PEDIATRIC CARDIOLOGY
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-3009
Practice Address - Country:US
Practice Address - Phone:305-662-8301
Practice Address - Fax:305-662-8304
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-23
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA002049208000000X
NC2012-00170208000000X
FLME1195562080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC1164609970Medicaid
SCQ0017EMedicaid
FLME119556OtherSTATE LICENSE
NC5920342Medicaid
NC1164609970Medicaid