Provider Demographics
NPI:1659603090
Name:BENDER, MARK IAN (MD, DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:IAN
Last Name:BENDER
Suffix:
Gender:M
Credentials:MD, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 KUHL AVE # MP31
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-2008
Mailing Address - Country:US
Mailing Address - Phone:407-841-5133
Mailing Address - Fax:407-237-6313
Practice Address - Street 1:311 N CLYDE MORRIS BLVD STE 440
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-2757
Practice Address - Country:US
Practice Address - Phone:386-241-1060
Practice Address - Fax:386-241-1061
Is Sole Proprietor?:No
Enumeration Date:2010-02-10
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH9908111N00000X
FLME149225208VP0014X
FLTRN27653390200000X
FL149225207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No111N00000XChiropractic ProvidersChiropractor
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program