Provider Demographics
NPI:1346256526
Name:SABBOTA, MARK G (DO)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:G
Last Name:SABBOTA
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:10650 W STATE ROAD 84
Mailing Address - Street 2:SUITE 104
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33324-4235
Mailing Address - Country:US
Mailing Address - Phone:954-382-1550
Mailing Address - Fax:954-382-1250
Practice Address - Street 1:10650 W STATE ROAD 84
Practice Address - Street 2:SUITE 104
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33324-4235
Practice Address - Country:US
Practice Address - Phone:954-382-1550
Practice Address - Fax:954-382-1250
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2021-03-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS8452207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL266497600Medicaid
H46168Medicare UPIN
FLE6046AMedicare ID - Type Unspecified