Provider Demographics
NPI:1184824542
Name:PAMER, MARK JON (DO)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JON
Last Name:PAMER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:573 NW LAKE WHITNEY PL STE 102
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-1628
Mailing Address - Country:US
Mailing Address - Phone:772-785-5864
Mailing Address - Fax:772-344-2555
Practice Address - Street 1:573 NW LAKE WHITNEY PL STE 102
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34986-1628
Practice Address - Country:US
Practice Address - Phone:772-785-5864
Practice Address - Fax:772-344-2555
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036115768207R00000X
FLOS9475207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine