Provider Demographics
NPI:1407037872
Name:DEL CID, MARIO R (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIO
Middle Name:R
Last Name:DEL CID
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 1:6333 N FEDERAL HWY
Mailing Address - Street 2:300
Mailing Address - City:FT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33308-1907
Mailing Address - Country:US
Mailing Address - Phone:954-776-6880
Mailing Address - Fax:954-229-3100
Practice Address - Street 1:6333 N FEDERAL HWY
Practice Address - Street 2:300
Practice Address - City:FT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-1907
Practice Address - Country:US
Practice Address - Phone:954-776-6880
Practice Address - Fax:954-229-3100
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.095080207W00000X
KYTP066207W00000X
FLME113175207W00000X, 207WX0107X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000654817OtherBCBS
KY7100112590Medicaid
FL006267400Medicaid
FL14MK5OtherBCBS
000000654817OtherBCBS
OH4286971Medicare PIN