Individual
DR. MARSHALL MATTHEW DESANTIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
14100 FIVAY RD, SUITE 300, HUDSON, FL 34667-7180
(727) 869-7497
(727) 869-7156
Mailing address
14100 FIVAY RD, SUITE 300, HUDSON, FL 34667-7180
(727) 869-7497
(727) 869-7156
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
ME0053627
FL
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
ME53627
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
048693100
—
FL
01
—
07035
BCBS FLORIDA
FL
01
—
083596
AVMED
—
Enumeration date
10/13/2006
Last updated
05/27/2008
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