Provider Demographics
NPI:1649283136
Name:SEARS, R MARK (MD)
Entity type:Individual
Prefix:
First Name:R
Middle Name:MARK
Last Name:SEARS
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 1:540 THE RIALTO
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2900
Mailing Address - Country:US
Mailing Address - Phone:941-480-2800
Mailing Address - Fax:941-486-6931
Practice Address - Street 1:540 THE RIALTO
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2900
Practice Address - Country:US
Practice Address - Phone:941-480-2800
Practice Address - Fax:941-486-6931
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84364207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL15942OtherBCBS
FL263582800Medicaid
FL15942AMedicare ID - Type Unspecified
FL263582800Medicaid