Provider Demographics
NPI:1568464410
Name:SHACHNER, MARK (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:SHACHNER
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 1:3001 CORAL HILLS DR
Mailing Address - Street 2:SUITE 320
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33065-4172
Mailing Address - Country:US
Mailing Address - Phone:954-755-0111
Mailing Address - Fax:954-755-2209
Practice Address - Street 1:3001 CORAL HILLS DR
Practice Address - Street 2:SUITE 320
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33065-4172
Practice Address - Country:US
Practice Address - Phone:954-755-0111
Practice Address - Fax:954-755-2209
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0062046208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370302900Medicaid
FLP00811387OtherMEDICARE RAILROAD
FL204679OtherAVMED
FL0163178OtherGHI
FL14969OtherBLUECROSSBLUESHIELD
FL002683OtherNHP
FL0100553OtherGHI
FLP00811387OtherMEDICARE RAILROAD
FL0100553OtherGHI