Individual
DR. GARY LEE MARDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
9580 S FEDERAL HWY, PORT SAINT LUCIE, FL 34952-4217
(772) 335-1500
(772) 335-1116
Mailing address
9580 S FEDERAL HWY, PORT SAINT LUCIE, FL 34952-4217
(772) 335-1500
(772) 335-1116
Taxonomy
Speciality
Code
Description
License number
State
207KA0200X
Allergy Physician
Primary
OS4773
FL
207KI0005X
Clinical & Laboratory Immunology (Allergy & Immunology) Physician
OS4773
FL
207ND0900X
Dermatopathology Physician
OS4773
FL
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
OS4773
FL
2085R0001X
Radiation Oncology Physician
OS4773
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
82760
BCBS
FL
Enumeration date
06/28/2006
Last updated
03/04/2008
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