Provider Demographics
NPI:1174557649
Name:DELEON, MARK CHRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:CHRISTOPHER
Last Name:DELEON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27 MACK BAYOU LOOP
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32459-2613
Mailing Address - Country:US
Mailing Address - Phone:850-622-0873
Mailing Address - Fax:850-622-1912
Practice Address - Street 1:27 MACK BAYOU LOOP
Practice Address - Street 2:
Practice Address - City:SANTA ROSA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32459-2613
Practice Address - Country:US
Practice Address - Phone:850-622-0873
Practice Address - Fax:850-622-1912
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0125207RH0003X
FLME146938207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP01547653OtherRAILROAD MEDICARE
TX186147801Medicaid
TX186147802Medicaid
TX8AA840OtherBLUECROSS/BLUESHIELD TX.
TX742782325OtherTAX ID
TXP01547653OtherRAILROAD MEDICARE
TX742782325OtherTAX ID
TXP000428860Medicare PIN