Provider Demographics
NPI:1235591025
Name:MARK C. DILLON, M.D. PLLC
Entity Type:Organization
Organization Name:MARK C. DILLON, M.D. PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:C
Authorized Official - Last Name:DILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-242-3227
Mailing Address - Street 1:3150 N WICKHAM RD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-2322
Mailing Address - Country:US
Mailing Address - Phone:321-242-3227
Mailing Address - Fax:
Practice Address - Street 1:3150 N WICKHAM RD
Practice Address - Street 2:SUITE 6
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-2322
Practice Address - Country:US
Practice Address - Phone:321-242-3227
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-22
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME63710207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty