Individual
MR. MARK WHITEHEAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
7243 DELLA DR, ORLANDO, FL 32819-5104
(407) 649-6878
(407) 423-1380
Mailing address
7243 DELLA DR, ORLANDO, FL 32819-5104
(407) 649-6878
(407) 423-1380
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
PA9106022
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
004300300
—
FL
Enumeration date
06/23/2011
Last updated
11/13/2018
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