Provider Demographics
NPI:1013993377
Name:SARGENT, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:SARGENT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1715 BERGLUND LN
Mailing Address - Street 2:SUITE B
Mailing Address - City:VIERA
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6230
Mailing Address - Country:US
Mailing Address - Phone:321-610-8955
Mailing Address - Fax:321-610-8954
Practice Address - Street 1:1715 BERGLUND LN
Practice Address - Street 2:SUITE B
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-6230
Practice Address - Country:US
Practice Address - Phone:321-610-8955
Practice Address - Fax:321-610-8954
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2015-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74593207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7845531OtherAETNA
FL3151723001OtherCIGNA
FL37841OtherBLUE CROSS BLUE SHIELD
FL269307100Medicaid
FL239793OtherWELLCARE
FL7845531OtherAETNA
FL269307100Medicaid