Provider Demographics
NPI:1790704153
Name:TAFFLIN, MARC EDWARD (DO)
Entity Type:Individual
Prefix:DR
First Name:MARC
Middle Name:EDWARD
Last Name:TAFFLIN
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:104 LINKSIDE CIR
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-2031
Mailing Address - Country:US
Mailing Address - Phone:904-273-4450
Mailing Address - Fax:904-273-2188
Practice Address - Street 1:1820 BARRS ST
Practice Address - Street 2:SUITE 601
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32204-4742
Practice Address - Country:US
Practice Address - Phone:904-384-8444
Practice Address - Fax:904-308-6089
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS36592081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD60632Medicare UPIN