Provider Demographics
NPI:1871586511
Name:DROFFNER, MARK C
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:C
Last Name:DROFFNER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 MILUS ST
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-3824
Mailing Address - Country:US
Mailing Address - Phone:941-637-0911
Mailing Address - Fax:941-637-9153
Practice Address - Street 1:260 MILUS ST
Practice Address - Street 2:
Practice Address - City:PUNTA GORDA
Practice Address - State:FL
Practice Address - Zip Code:33950-3824
Practice Address - Country:US
Practice Address - Phone:941-637-0911
Practice Address - Fax:941-637-9153
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-29
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0006075207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL80477OtherBCBS
FL053387400Medicaid
FL80477Medicare ID - Type Unspecified
FL053387400Medicaid
FL80477OtherBCBS