Provider Demographics
NPI:1801968508
Name:YALLOF, MARC (DO)
Entity type:Individual
Prefix:
First Name:MARC
Middle Name:
Last Name:YALLOF
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1708 CAPE CORAL PKWY W
Mailing Address - Street 2:SUITE 2
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33914-6985
Mailing Address - Country:US
Mailing Address - Phone:239-333-3333
Mailing Address - Fax:239-333-3332
Practice Address - Street 1:1708 CAPE CORAL PKWY W
Practice Address - Street 2:SUITE 2
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33914-6985
Practice Address - Country:US
Practice Address - Phone:239-333-3333
Practice Address - Fax:239-333-3332
Is Sole Proprietor?:No
Enumeration Date:2006-11-15
Last Update Date:2011-04-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLOS5859208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC56563Medicare UPIN
FL80546WMedicare PIN