Provider Demographics
NPI:1568664522
Name:NAKAJIMA, MARK Y (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:Y
Last Name:NAKAJIMA
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 1:7700 W SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33322-4113
Mailing Address - Country:US
Mailing Address - Phone:954-265-5423
Mailing Address - Fax:954-962-6974
Practice Address - Street 1:7700 W SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-4113
Practice Address - Country:US
Practice Address - Phone:954-265-5423
Practice Address - Fax:954-962-6974
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105883207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL149EHOtherBCBS
XXX-XX-2080OtherCHAMPUS / TRICARE SOUTH REGION
FLDK075ZMedicare PIN