Provider Demographics
NPI:1831416676
Name:JEFFREY L. MARKS, MD, PA
Entity type:Organization
Organization Name:JEFFREY L. MARKS, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:MARKS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-587-7010
Mailing Address - Street 1:7390 NW 5TH ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-1610
Mailing Address - Country:US
Mailing Address - Phone:954-587-7010
Mailing Address - Fax:954-587-7010
Practice Address - Street 1:7390 NW 5TH ST
Practice Address - Street 2:SUITE 7
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-1610
Practice Address - Country:US
Practice Address - Phone:954-587-7010
Practice Address - Fax:954-587-7010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-03
Last Update Date:2024-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL57712208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL10447Medicare PIN
FLES007AMedicare PIN
FL10447XMedicare PIN