Provider Demographics
NPI:1912982802
Name:PERMAN, MARK L (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:L
Last Name:PERMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2234 COLONIAL BLVD
Mailing Address - Street 2:ATTN: PAYER CONTRACTING & RELATIONS DEPT.
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33907-1412
Mailing Address - Country:US
Mailing Address - Phone:239-931-7342
Mailing Address - Fax:239-931-7385
Practice Address - Street 1:2107 SE OCEAN BLVD
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34996-3305
Practice Address - Country:US
Practice Address - Phone:772-403-2390
Practice Address - Fax:772-403-2395
Is Sole Proprietor?:No
Enumeration Date:2005-12-13
Last Update Date:2016-10-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLFLME59298174400000X
FLME592982085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL11781OtherBCBS
FL278876OtherAVMED
FL4335023OtherAETNA
FL11781OtherBLUE CROSS BLUE SHIELD
FL1613633OtherCIGNA
FLP01572583OtherRR MEDICARE
FL1249231OtherWELLCARE
FL374538400Medicaid
FLP106954OtherFREEDOM
FLP938826OtherOPTIMUM
FL11781OtherBLUE CROSS BLUE SHIELD
FL4335023OtherAETNA
FL11781YMedicare PIN
FL11781UMedicare PIN