Provider Demographics
NPI:1477558088
Name:YARBOROUGH, MARK ALAN (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALAN
Last Name:YARBOROUGH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:1 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-4500
Practice Address - Country:US
Practice Address - Phone:828-253-5314
Practice Address - Fax:828-254-5216
Is Sole Proprietor?:No
Enumeration Date:2005-06-20
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC32452208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP00996851OtherRAILROAD MEDICARE
NC4375686OtherAETNA
NC7989671Medicaid
NCNC2871AMedicare PIN
NC7989671Medicaid
NC4375686OtherAETNA