Organization
MARK A EBERBACH MD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK ALLEN EBERBACH MD (PRESIDENT)
(727) 868-4490
Entity
Organization
Contact information
Practice address
14012 US HIGHWAY 19, HUDSON, FL 34667-1165
(727) 868-4490
(727) 869-7085
Mailing address
14012 US HIGHWAY 19, HUDSON, FL 34667-1165
(727) 868-4490
(727) 869-7085
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
ME0048142
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
07923
BLUE CROSS BLUE SHIELD
FL
01
—
E31250
UPIN
FL
01
—
K5399
MEDICARE PROVIDER NUMBER
FL
Enumeration date
08/18/2008
Last updated
03/16/2009
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