Provider Demographics
NPI:1184696858
Name:MARK E POMPER MD PA
Entity type:Organization
Organization Name:MARK E POMPER MD PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ELLIOT
Authorized Official - Last Name:POMPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-730-3333
Mailing Address - Street 1:PO BOX 2277
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140
Mailing Address - Country:US
Mailing Address - Phone:954-730-2333
Mailing Address - Fax:
Practice Address - Street 1:1036 NW 1ST AVE
Practice Address - Street 2:
Practice Address - City:HOMESTEAD
Practice Address - State:FL
Practice Address - Zip Code:33030-4417
Practice Address - Country:US
Practice Address - Phone:954-730-2333
Practice Address - Fax:954-730-2337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-06
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252860600Medicaid
FL33637Medicare PIN