Provider Demographics
NPI:1598767543
Name:NORES, MARCOS AGUSTIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARCOS
Middle Name:AGUSTIN
Last Name:NORES
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 1:5301 SOUTH CONGRESS AVE. SUITE 300
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462
Mailing Address - Country:US
Mailing Address - Phone:561-548-4900
Mailing Address - Fax:561-548-4902
Practice Address - Street 1:5301 S CONGRESS AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:ATLANTIS
Practice Address - State:FL
Practice Address - Zip Code:33462-1149
Practice Address - Country:US
Practice Address - Phone:561-548-4900
Practice Address - Fax:561-548-4900
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-10
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME108415208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64074255Medicaid
FL003918300Medicaid
KYCJ6802OtherPALMETTO
KY64074255Medicaid
H28044Medicare UPIN
KY0697603Medicare ID - Type Unspecified
KYH28044Medicare UPIN