Provider Demographics
NPI:1952346918
Name:MARKS, JEFFREY L (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:L
Last Name:MARKS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
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:954-587-7020
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:954-587-7020
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2010-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0057712208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC18800Medicare UPIN
FL10447Medicare ID - Type Unspecified