Provider Demographics
NPI:1902875735
Name:ATKINS, MARK JAY (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:JAY
Last Name:ATKINS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:733 BLUE SEAS CT
Mailing Address - Street 2:
Mailing Address - City:PONTE VEDRA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32082-4553
Mailing Address - Country:US
Mailing Address - Phone:904-217-4399
Mailing Address - Fax:904-371-2826
Practice Address - Street 1:733 BLUE SEAS CT
Practice Address - Street 2:
Practice Address - City:PONTE VEDRA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32082-4553
Practice Address - Country:US
Practice Address - Phone:904-217-4399
Practice Address - Fax:904-371-2826
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-15
Last Update Date:2013-12-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME 102348207RS0012X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
C55074Medicare UPIN