Provider Demographics
NPI:1730161639
Name:KLAFTER, MARK JEFFREY (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:JEFFREY
Last Name:KLAFTER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3849 OAKWATER CIR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6264
Mailing Address - Country:US
Mailing Address - Phone:407-240-1762
Mailing Address - Fax:407-812-5869
Practice Address - Street 1:3849 OAKWATER CIR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-6264
Practice Address - Country:US
Practice Address - Phone:407-240-1762
Practice Address - Fax:407-812-5869
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6959204D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL5424127OtherAETNA
FL57156OtherBLUECROSS BLUESHIELD
FL130020567OtherRAILROAD MEDICARE
FL377881900Medicaid
FL5221819-006OtherCIGNA
FL5221819-006OtherCIGNA
G07491Medicare UPIN