Provider Demographics
NPI:1225034176
Name:BLOCK, MARK STEWART (DPM PA)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:STEWART
Last Name:BLOCK
Suffix:
Gender:M
Credentials:DPM PA
Other - Prefix:
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Mailing Address - Street 1:660 GLADES RD
Mailing Address - Street 2:STE 120
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-6466
Mailing Address - Country:US
Mailing Address - Phone:561-368-3232
Mailing Address - Fax:561-368-3234
Practice Address - Street 1:660 GLADES RD
Practice Address - Street 2:STE 120
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-6466
Practice Address - Country:US
Practice Address - Phone:561-368-3232
Practice Address - Fax:561-368-3234
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-24
Last Update Date:2020-07-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLPO1182213ES0000X, 213ES0103X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No213ES0000XPodiatric Medicine & Surgery Service ProvidersPodiatristSports Medicine
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0976020001Medicare NSC
FLT95162Medicare UPIN
FL87641Medicare PIN