Provider Demographics
NPI:1952735219
Name:DREYER, MARK A (DPM, FACAFAS)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:DREYER
Suffix:
Gender:M
Credentials:DPM, FACAFAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11505 RANGELAND PKWY
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34211-4041
Mailing Address - Country:US
Mailing Address - Phone:941-362-8662
Mailing Address - Fax:941-362-8602
Practice Address - Street 1:11505 RANGELAND PKWY
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34211-4041
Practice Address - Country:US
Practice Address - Phone:941-362-8662
Practice Address - Fax:941-362-8602
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00347171000000X, 213ES0103X
FLPO4081213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No171000000XOther Service ProvidersMilitary Health Care Provider