Provider Demographics
NPI:1275521221
Name:RINER, MARK ALLEN (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:ALLEN
Last Name:RINER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1893 N CLYDE MORRIS BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117-5535
Mailing Address - Country:US
Mailing Address - Phone:386-677-0531
Mailing Address - Fax:386-672-7515
Practice Address - Street 1:1893 N CLYDE MORRIS BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117-5535
Practice Address - Country:US
Practice Address - Phone:386-677-0531
Practice Address - Fax:386-672-7515
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2016-12-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME 50466207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL373091300Medicaid
FLD50686Medicare UPIN
02937YMedicare PIN