Provider Demographics
NPI:1982686796
Name:IRELAND, MARK L (D O)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:L
Last Name:IRELAND
Suffix:
Gender:M
Credentials:D O
Other - Prefix:
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Mailing Address - Street 1:1380 S PATRICK DR
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4375
Mailing Address - Country:US
Mailing Address - Phone:321-773-2659
Mailing Address - Fax:321-773-2667
Practice Address - Street 1:1380 S PATRICK DR
Practice Address - Street 2:
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4375
Practice Address - Country:US
Practice Address - Phone:321-773-2659
Practice Address - Fax:321-773-2667
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2015-11-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS5184207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80128XMedicare PIN