Provider Demographics
NPI:1336126358
Name:FLORA, MARK D (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:FLORA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2801 CHARLOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37209-4035
Mailing Address - Country:US
Mailing Address - Phone:615-250-9200
Mailing Address - Fax:615-250-9251
Practice Address - Street 1:2801 CHARLOTTE AVE
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-4035
Practice Address - Country:US
Practice Address - Phone:615-250-9200
Practice Address - Fax:615-250-9251
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNMD18008208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3059623Medicaid
KY64799158Medicaid
TN0157614OtherBLUE CROSS
TN340013311OtherRR MEDICARE
TN3059623Medicaid