Provider Demographics
NPI:1497853733
Name:MATHURIN, MARK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:MATHURIN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:861 SW 78TH AVE
Mailing Address - Street 2:#100B
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-3273
Mailing Address - Country:US
Mailing Address - Phone:954-693-0000
Mailing Address - Fax:954-693-0005
Practice Address - Street 1:1500 S MILL AVE
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:TEMPE
Practice Address - State:AZ
Practice Address - Zip Code:85281-6699
Practice Address - Country:US
Practice Address - Phone:480-784-5533
Practice Address - Fax:480-333-5197
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2023-10-06
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Provider Licenses
StateLicense IDTaxonomies
AZ23700208M00000X, 207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G30484Medicare UPIN