Provider Demographics
NPI:1356314934
Name:WHITESIDE, MARK ERIC (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ERIC
Last Name:WHITESIDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 BAHAMA DR
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-5217
Mailing Address - Country:US
Mailing Address - Phone:305-293-8294
Mailing Address - Fax:
Practice Address - Street 1:1100 SIMONTON ST
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-3110
Practice Address - Country:US
Practice Address - Phone:305-809-5280
Practice Address - Fax:305-293-1561
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2015-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0036940207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL069424000Medicaid
FL069424000Medicaid
FL44189YMedicare ID - Type UnspecifiedMONROE COUNTY HEALTH DEPT
FL44189UMedicare ID - Type UnspecifiedPRIVATE PRATICE