Marc Jeffrey Mallis, MD

Primary specialty

Ophthalmology PhysicianTaxonomy code 207W00000X

License

ME 0037030 Issued in FL

Practice address

5347 Main St
Ste 102
New Port Richey, FL 34652-2506

Phone

(727) 845-1343

Fax

(727) 845-1343

NPI assigned

Jun 15, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Gregory L Henderson MD Facs Inc

  • Ophthalmology Physician
  • Tampa, FL
  • NPI 1952139347
  NPD (past)
• Pautler Cohen Findlay Eichenbaum White and Crane MDS PA

  • Retina Specialist (Ophthalmology) Physician
  • Palm Harbor, FL
  • NPI 1588384093
  NPD (past)
• Retina Vitrous Consultants of West Florida PL

  • Ophthalmology Physician
  • New Port Richey, FL
  • NPI 1144321571
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1118793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1235433600000",
    "number": "1811992050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2975 ROLLING WOODS DR",
            "city": "PALM HARBOR",
            "state": "FL",
            "postal_code": "346832131",
            "telephone_number": "727-784-8060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5347 MAIN ST",
            "address_2": "STE 102",
            "city": "NEW PORT RICHEY",
            "state": "FL",
            "postal_code": "346522506",
            "telephone_number": "727-845-1343",
            "fax_number": "727-845-1343"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MALLIS",
        "first_name": "MARC",
        "middle_name": "JEFFREY",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-06-15",
        "last_updated": "2009-02-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "FL",
            "license": "ME 0037030",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "054865101",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mainstream Diagnostic Laboratory LLC
• Shonna Monique Mallard
• Sally Mallery, LMHC
• Malleswari S Vangara MD PA
• Sarah Mallett, MD
• Mammolink LLC
• Joseph Michael Mancusi, D.C.
• Hanan Milad Mankarious, PHARMD
• Madison Manke
• William Thomas Manley, APRN

• Ophthalmology Physician in New Port Richey, FL
• Providers in New Port Richey, FL by specialty
• Ophthalmology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 24, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.