Provider Demographics
NPI:1720168826
Name:LAPORTA, MARK ANTONY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:ANTONY
Last Name:LAPORTA
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:PO BOX 456
Mailing Address - Street 2:
Mailing Address - City:ROSELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32957-0456
Mailing Address - Country:US
Mailing Address - Phone:772-388-9595
Mailing Address - Fax:
Practice Address - Street 1:13305 ROSELAND ROAD #456
Practice Address - Street 2:MARK ANTONY LAPORTA MD FACP LOCUMS NOT PATIENTS
Practice Address - City:ROSELAND
Practice Address - State:FL
Practice Address - Zip Code:32957-0456
Practice Address - Country:US
Practice Address - Phone:772-388-9595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLFLME0041885207R00000X
FLME41885207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067-060766Medicaid
FL96222OtherBCBS
FL067-060766Medicaid
FL96222OtherBCBS
FL96222BMedicare PIN
FLD14854Medicare UPIN