Active NPI 1306841473 Individual Practitioner Male Practitioner

Dr. Mark R Licht , MD

Urology • Orlando, FL

✓ Accepts Medicare Assignment

Professional Overview & Biography Verified Profile Summary

Dr. Mark Licht, MD is a certified Urology practicing in Orlando, FL. With approximately 38 years of clinical experience since graduating from University Of Rochester School Of Medicine And Dentistry in 1988, Dr. Licht delivers high-quality medical care to the local community at 258 S CHICKASAW TRL STE 202.

Dr. Licht is affiliated with Florida Hospital Medical Group Inc and accepts Medicare assignment.

Frequently performed procedures and clinical services include injection, onabotulinumtoxina, 1 unit, established patient outpatient office visit, automated urinalysis test. Full Medicare procedure pricing transparency rates and service volume details are listed on this profile.

Practice Location & Contact Primary Location

Practice Address

258 S Chickasaw Trl Ste 202

Orlando, FL 328253501

Telephone 4073036865

Fax 4073036537

Associated Practice Facility / Clinic

🏢 North Brevard Medical Support, Inc Facility NPI 1609834886

Medicare Profile & Education

Medical School

University Of Rochester School Of Medicine And Dentistry

Graduation Year

1988

Medicare Assignment

✓ Accepts Assignment

Telehealth Flag

In-Person Only

Specialty Benchmarks & Practice Insights

Comparative analytics for Urology in Orlando, FL

Senior Veteran Specialist (>20 Yrs)

Practitioner Clinical Experience

38 Yrs +12.0 yrs vs City Avg

City Avg: 26.0 Yrs

State Avg: 29.7 Yrs

Regional Practice Density

51 Specialists

Practicing in Orlando, FL (1082 Statewide)

Telehealth Adoption Rate

25.5% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

50.0% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Clinical Seniority & Experience Comparison

Dr. Licht (38 Years) 38 Yrs

Orlando Specialty Average (26.0 Years) 26.0 Yrs

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J0585 Injection, onabotulinumtoxina, 1 unit	1,550	14	$11.00	$6.25
99213 Established patient office or other outpatient visit, typically 15 minutes	479	287	$170.35	$87.61
81003 Automated urinalysis test	473	326	$5.00	$2.20
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	287	237	$238.67	$123.86
36415 Insertion of needle into vein for collection of blood sample	217	185	$20.00	$8.61
J0696 Injection, ceftriaxone sodium, per 250 mg	140	23	$1.00	$0.45
J9217 Leuprolide acetate (for depot suspension), 7.5 mg	99	13	$418.00	$178.20
52000 Diagnostic exam of bladder and urethra using an endoscope	74	59	$410.12	$227.18
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	64	64	$328.81	$161.67
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	50	46	$276.00	$128.29
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	48	48	$217.42	$108.94
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	46	23	$34.00	$13.72
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	45	27	$152.53	$77.10
96402 Administration of hormonal anti-neoplastic chemotherapy under skin or into muscle	35	14	$62.00	$33.23
99231 Follow-up hospital inpatient care per day, typically 15 minutes	23	14	$80.00	$48.57
76942 Ultrasonic guidance imaging supervision and interpretation for insertion of needle	20	20	$114.00	$55.40
55700 Biopsy of prostate gland	20	20	$502.00	$232.51
76857 Limited ultrasound scan of pelvis	16	16	$98.00	$46.92
52287 Exam with injections of chemical for destruction of bladder using an endoscope	16	15	$684.00	$370.51

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J0585 Injection, onabotulinumtoxina, 1 unit	1,300	12	$11.00	$6.25
81003 Automated urinalysis test	698	470	$5.00	$2.19
99213 Established patient office or other outpatient visit, typically 15 minutes	546	318	$146.00	$89.68
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	325	279	$214.00	$127.01
36415 Insertion of needle into vein for collection of blood sample	205	165	$20.00	$8.36
J9217 Leuprolide acetate (for depot suspension), 7.5 mg	99	12	$418.00	$170.13
52000 Diagnostic exam of bladder and urethra using an endoscope	72	58	$332.00	$236.59
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	69	69	$216.00	$112.48
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	65	65	$330.00	$166.99
J0696 Injection, ceftriaxone sodium, per 250 mg	56	14	$1.00	$0.49
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	43	27	$148.00	$80.03
51702 Simple insertion of temporary bladder tube	32	15	$130.00	$59.86
96402 Administration of hormonal anti-neoplastic chemotherapy under skin or into muscle	31	12	$62.00	$32.98
99231 Follow-up hospital inpatient care per day, typically 15 minutes	31	19	$80.00	$50.71
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	20	20	$276.00	$132.02
76857 Limited ultrasound scan of pelvis	16	15	$98.00	$48.14
52287 Exam with injections of chemical for destruction of bladder using an endoscope	15	14	$684.00	$386.22
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	15	15	$34.00	$13.93
55700 Biopsy of prostate gland	14	14	$502.00	$240.49
76942 Ultrasonic guidance imaging supervision and interpretation for insertion of needle	14	14	$114.00	$57.79
52332 Insertion of stent in urinary duct (ureter) using an endoscope	12	11	$982.00	$137.19
51700 Simple bladder irrigation and/or instillation	12	11	$148.00	$75.41

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J0585 Injection, onabotulinumtoxina, 1 unit	3,400	24	$11.00	$6.14
81003 Automated urinalysis test	857	531	$5.00	$2.22
99213 Established patient office or other outpatient visit, typically 15 minutes	501	288	$146.00	$90.65
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	358	324	$214.00	$127.76
36415 Insertion of needle into vein for collection of blood sample	163	136	$20.00	$2.89
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	118	118	$216.00	$113.48
52000 Diagnostic exam of bladder and urethra using an endoscope	81	62	$332.00	$244.66
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	79	79	$330.00	$167.41
99231 Follow-up hospital inpatient care per day, typically 15 minutes	44	25	$80.00	$39.25
99221 Initial hospital inpatient care per day, typically 30 minutes	41	38	$206.00	$102.49
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	35	17	$148.00	$72.05
51702 Simple insertion of temporary bladder tube	32	12	$130.00	$62.48
52287 Exam with injections of chemical for destruction of bladder using an endoscope	31	24	$684.00	$398.01
76857 Limited ultrasound scan of pelvis	18	14	$98.00	$46.44
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	13	12	$34.00	$14.23
52601 Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope	12	12	$1516.00	$747.97
76942 Ultrasonic guidance imaging supervision and interpretation for insertion of needle	11	11	$114.00	$58.28
55700 Biopsy of prostate gland	11	11	$502.00	$245.39

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J0585 Injection, onabotulinumtoxina, 1 unit	1,400	12	$11.00	$6.07
81003 Automated urinalysis test	772	500	$5.00	$2.24
99213 Established patient office or other outpatient visit, typically 15 minutes	401	244	$146.00	$91.66
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	312	283	$214.00	$129.42
36415 Insertion of needle into vein for collection of blood sample	145	121	$20.00	$2.96
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	124	124	$216.00	$113.31
99231 Follow-up hospital inpatient care per day, typically 15 minutes	102	47	$80.00	$38.83
52000 Diagnostic exam of bladder and urethra using an endoscope	74	60	$332.00	$233.32
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	65	65	$330.00	$165.79
99221 Initial hospital inpatient care per day, typically 30 minutes	62	59	$206.00	$101.68
J1580 Injection, garamycin, gentamicin, up to 80 mg	40	18	$3.00	$1.83
51702 Simple insertion of temporary bladder tube	37	12	$130.00	$63.74
76857 Limited ultrasound scan of pelvis	30	27	$98.00	$47.82
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	28	20	$88.00	$56.23
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	22	18	$34.00	$14.09
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	21	13	$148.00	$72.72
51701 Insertion of temporary bladder tube	14	12	$96.00	$46.37
76942 Ultrasonic guidance imaging supervision and interpretation for insertion of needle	14	14	$114.00	$58.15
55700 Biopsy of prostate gland	14	14	$502.00	$253.11
52287 Exam with injections of chemical for destruction of bladder using an endoscope	12	12	$684.00	$390.70

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J0585 Injection, onabotulinumtoxina, 1 unit	2,100	16	$11.00	$6.07
81003 Automated urinalysis test	669	349	$5.00	$2.23
99213 Established patient office or other outpatient visit, typically 15 minutes	408	207	$146.00	$74.36
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	269	222	$214.00	$107.48
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	118	32	$148.00	$73.48
36415 Insertion of needle into vein for collection of blood sample	98	77	$20.00	$2.92
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	88	88	$216.00	$108.22
99231 Follow-up hospital inpatient care per day, typically 15 minutes	69	32	$80.00	$40.44
52000 Diagnostic exam of bladder and urethra using an endoscope	64	55	$332.00	$208.36
99221 Initial hospital inpatient care per day, typically 30 minutes	58	46	$206.00	$105.16
76857 Limited ultrasound scan of pelvis	46	39	$98.00	$46.97
51700 Simple bladder irrigation and/or instillation	44	31	$148.00	$75.36
J1580 Injection, garamycin, gentamicin, up to 80 mg	41	19	$3.00	$1.81
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	33	23	$34.00	$13.70
51702 Simple insertion of temporary bladder tube	32	18	$130.00	$61.09
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	31	31	$330.00	$161.52
52287 Exam with injections of chemical for destruction of bladder using an endoscope	18	16	$684.00	$363.51
76872 Ultrasound scan of pelvic region through rectum	15	14	$252.00	$139.62
76942 Ultrasonic guidance imaging supervision and interpretation for insertion of needle	14	13	$114.00	$56.88
55700 Biopsy of prostate gland	14	13	$502.00	$250.21
52310 Simple removal of foreign body, stone, or stent in urethra or bladder using an endoscope	13	13	$496.00	$270.32

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J1071 Injection, testosterone cypionate, 1 mg	7,300	11	$0.15	$0.03
J0585 Injection, onabotulinumtoxina, 1 unit	3,000	22	$13.47	$6.03
81003 Automated urinalysis test	900	694	$13.09	$2.43
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	420	393	$190.88	$109.72
99213 Established patient office or other outpatient visit, typically 15 minutes	407	300	$132.17	$74.98
36415 Insertion of needle into vein for collection of blood sample	221	206	$12.79	$2.94
84153 Psa (prostate specific antigen) measurement, total	170	165	$68.00	$20.03
J9217 Leuprolide acetate (for depot suspension), 7.5 mg	109	30	$800.00	$232.44
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	104	104	$193.50	$110.72
52000 Diagnostic exam of bladder and urethra using an endoscope	103	101	$441.28	$193.45
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	65	32	$34.86	$17.05
51700 Simple bladder irrigation and/or instillation	54	37	$238.07	$75.40
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	52	41	$98.38	$45.52
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	52	52	$328.27	$160.79
76857 Limited ultrasound scan of pelvis	52	43	$122.00	$48.30
99232 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 35 minutes	48	23	$148.04	$73.18
51702 Simple insertion of temporary bladder tube	43	24	$160.93	$61.95
51705 Removal of skin suture with change of bladder tube	38	15	$248.26	$98.57
J0696 Injection, ceftriaxone sodium, per 250 mg	35	12	$14.71	$0.57
96402 Administration of hormonal anti-neoplastic chemotherapy under skin or into muscle	30	30	$80.00	$31.59
84154 Psa (prostate specific antigen) measurement, free	29	28	$68.00	$20.03
76770 Complete ultrasound scan behind abdominal cavity	29	28	$248.28	$115.59
99233 Subsequent hospital care with moderate levelof medical decision making, if using time, at least 50 minutes	25	14	$207.20	$105.57
99223 Initial hospital care with moderate level of medical decision making, if using time, at least 75 minutes	22	21	$410.00	$203.33
52287 Exam with injections of chemical for destruction of bladder using an endoscope	21	21	$1383.43	$353.15
J1580 Injection, garamycin, gentamicin, up to 80 mg	16	12	$19.50	$1.71
88112 Cell examination of specimen, selective cellular enhancement technique	12	12	$80.00	$39.65
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	12	11	$260.83	$141.18
76942 Ultrasonic guidance imaging supervision and interpretation for insertion of needle	11	11	$148.91	$56.61
81002 Urinalysis, manual test	11	11	$15.00	$3.41
76872 Ultrasound scan of pelvic region through rectum	11	11	$239.82	$125.20
55700 Biopsy of prostate gland	11	11	$483.45	$251.32

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J1071 Injection, testosterone cypionate, 1 mg	40,400	26	$0.15	$0.02
J0585 Injection, onabotulinumtoxina, 1 unit	5,800	38	$15.00	$5.85
81003 Automated urinalysis test	2,664	1,497	$17.00	$2.71
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	1,375	987	$175.00	$110.58
99213 Established patient office or other outpatient visit, typically 15 minutes	911	556	$125.00	$75.06
36415 Insertion of needle into vein for collection of blood sample	796	583	$11.00	$2.92
84153 Psa (prostate specific antigen) measurement, total	783	593	$68.00	$22.26
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	443	443	$180.00	$112.35
J9217 Leuprolide acetate (for depot suspension), 7.5 mg	340	45	$800.00	$212.75
52000 Diagnostic exam of bladder and urethra using an endoscope	299	231	$500.00	$172.77
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	275	64	$35.00	$20.37
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	192	134	$100.00	$45.35
88112 Cell examination of specimen, selective cellular enhancement technique	154	135	$80.00	$40.81
84154 Psa (prostate specific antigen) measurement, free	144	116	$68.00	$22.26
51700 Simple bladder irrigation and/or instillation	140	38	$300.00	$76.82
76770 Complete ultrasound scan behind abdominal cavity	138	125	$250.00	$116.98
51705 Removal of skin suture with change of bladder tube	129	15	$250.00	$96.37
76857 Limited ultrasound scan of pelvis	100	67	$150.00	$49.76
96402 Administration of hormonal anti-neoplastic chemotherapy under skin or into muscle	95	45	$80.00	$31.41
51702 Simple insertion of temporary bladder tube	95	47	$200.00	$66.45
J0696 Injection, ceftriaxone sodium, per 250 mg	94	16	$25.00	$0.61
51720 Instillation of anti-cancer drug into bladder	79	19	$425.00	$88.63
J9031 Bcg (intravesical) per instillation	78	18	$200.00	$134.94
J1580 Injection, garamycin, gentamicin, up to 80 mg	57	31	$25.00	$1.44
84403 Testosterone (hormone) level, total	49	34	$60.00	$31.23
52287 Exam with injections of chemical for destruction of bladder using an endoscope	46	38	$1500.00	$326.22
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	32	31	$250.00	$143.49
99231 Follow-up hospital inpatient care per day, typically 15 minutes	31	19	$125.00	$39.93
52224 Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope	24	20	$2000.00	$726.81
51798 Ultrasound measurement of bladder capacity after voiding	16	16	$100.00	$16.41
51701 Insertion of temporary bladder tube	15	13	$175.00	$49.85

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J1071 Injection, testosterone cypionate, 1 mg	31,400	16	$0.15	$0.02
J0585 Injection, onabotulinumtoxina, 1 unit	6,300	34	$15.00	$5.62
81003 Automated urinalysis test	2,665	1,406	$17.00	$3.02
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	1,382	985	$175.00	$107.18
99213 Established patient office or other outpatient visit, typically 15 minutes	990	597	$125.05	$72.90
36415 Insertion of needle into vein for collection of blood sample	794	564	$11.00	$2.92
84153 Psa (prostate specific antigen) measurement, total	768	577	$68.00	$24.70
J9217 Leuprolide acetate (for depot suspension), 7.5 mg	379	49	$800.00	$209.43
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	367	216	$100.00	$43.55
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	342	342	$180.00	$109.10
52000 Diagnostic exam of bladder and urethra using an endoscope	313	235	$500.00	$166.51
96372 Injection beneath the skin or into muscle for therapy, diagnosis, or prevention	207	54	$35.00	$23.56
51700 Simple bladder irrigation and/or instillation	203	50	$300.00	$72.97
88112 Cell examination of specimen, selective cellular enhancement technique	183	161	$80.00	$39.11
84154 Psa (prostate specific antigen) measurement, free	148	122	$68.00	$24.73
76770 Complete ultrasound scan behind abdominal cavity	139	126	$250.00	$113.46
99231 Follow-up hospital inpatient care per day, typically 15 minutes	118	50	$125.00	$39.78
51702 Simple insertion of temporary bladder tube	113	43	$200.00	$63.80
96402 Administration of hormonal anti-neoplastic chemotherapy under skin or into muscle	112	50	$80.00	$32.56
J0696 Injection, ceftriaxone sodium, per 250 mg	92	20	$25.00	$0.63
76857 Limited ultrasound scan of pelvis	84	55	$150.00	$48.56
51705 Removal of skin suture with change of bladder tube	81	11	$250.00	$91.95
J9031 Bcg (intravesical) per instillation	76	22	$200.00	$126.75
51720 Instillation of anti-cancer drug into bladder	76	22	$425.00	$89.54
99222 Initial hospital care with straightforward or low-level medical decision making, if using time, at least 55 minutes	66	60	$250.00	$138.76
J1580 Injection, garamycin, gentamicin, up to 80 mg	53	35	$25.00	$1.51
52287 Exam with injections of chemical for destruction of bladder using an endoscope	49	34	$1500.00	$304.87
52224 Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope	43	29	$2000.00	$696.08
84403 Testosterone (hormone) level, total	36	29	$60.00	$34.70
51798 Ultrasound measurement of bladder capacity after voiding	34	25	$100.00	$19.74
51701 Insertion of temporary bladder tube	16	16	$175.00	$48.39
51741 Electronic assessment of bladder emptying	16	16	$225.00	$8.06
76942 Ultrasonic guidance imaging supervision and interpretation for insertion of needle	14	13	$300.00	$60.33
55700 Biopsy of prostate gland	14	13	$400.00	$252.17
76872 Ultrasound scan of pelvic region through rectum	14	13	$245.00	$94.69
52224 Destruction of (less than 0.5 centimeters) growths of the bladder and bladder canal (urethra) using an endoscope	13	12	$2000.00	$215.11
76775 Limited ultrasound scan behind abdominal cavity	13	13	$200.00	$58.65
52332 Insertion of stent in urinary duct (ureter) using an endoscope	13	11	$1600.00	$174.71
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	13	13	$240.00	$165.82
52214 Destruction of tissue of bladder, urethra, or surrounding glands using an endoscope	12	11	$2000.00	$664.27
G0416 Surgical pathology, gross and microscopic examinations, for prostate needle biopsy, any method	12	12	$1560.00	$297.93
76870 Ultrasound scan of scrotum	11	11	$175.00	$62.40
52601 Electro-removal of prostate through bladder canal (urethra) with control of bleeding using an endoscope	11	11	$2700.00	$885.99

Medical Specialties & State Licenses

CMS Verified: 2026-07-17

Urology Primary Specialty

NUCC Taxonomy Code: 208800000X

State License FL ME68004

A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures.

Additional State Medicaid & Healthcare Payer Identifiers

Medicaid State Provider ID

101986000 (FL)

Hospital & Practice Group Affiliations

Florida Hospital Medical Group Inc

2600 Westhall Ln, Maitland, FL 327517102

Phone: 4072002700

Secondary Practice Locations

1600 Lakeland Hills Blvd

Lakeland, FL 338053019

Phone: 8636807000

825 Century Medical Dr

Titusville, FL 327962113

Phone: 3212686868

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

13 Associated Practitioners

Dr. Daniel Zapata Vargas , MD

Urology

NPI 1144662875

Doctor of Medicine (M.D.)

Manuel Cruz-Diaz

Urology - Pediatric Urology

NPI 1164696118

Nicolas Taylor , PA-C

Physician Assistant

NPI 1205400678

Physician Assistant (Certified)

Dr. Stephen Dobkin , MD

Urology

NPI 1306899893

Doctor of Medicine (M.D.)

Dona Thomas

Nurse Practitioner - Family

NPI 1366274474

Perry Moore , PA-C

Physician Assistant

NPI 1447241831

Physician Assistant (Certified)

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

10 Historical Events

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) July 17, 2026

Urology (License #ME68004 in FL)

📍

Updated Practice Location April 29, 2025

Registered at 258 S CHICKASAW TRL STE 202, ORLANDO, FL 328253501 (Tel: 4073036865)

📍

Updated Practice Location April 02, 2019

Registered at 825 CENTURY MEDICAL DR, TITUSVILLE, FL 327962113 (Tel: 3212686868)

📍

Updated Business Mailing Address April 02, 2019

Registered at 805 CENTURY MEDICAL DR STE C, TITUSVILLE, FL 327962100 (Tel: 3212686868)

✅

NPI Profile Active August 04, 2015

NPI status registered as active in NPPES database

📍

Updated Practice Location August 04, 2015

Registered at 7280 W PALMETTO PARK RD, STE 305, BOCA RATON, FL 334333422 (Tel: 5619556025)

📍

Updated Business Mailing Address August 04, 2015

Registered at 5350 W. ATLANTIC AVENUE, SUITE 102, DELRAY BEACH, FL 334848122 (Tel: 5614964444)

👤

Provider Name / Credentials Updated August 04, 2015

Recorded as MARK LICHT, M.D.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) August 04, 2015

Specialist (License #ME68004 in FL)

🟢

Initial NPI Registration & Enumeration June 16, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

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NPI Administrative Meta

NPI Number: 1306841473

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: June 16, 2005

Last Update: July 17, 2026

Sole Proprietor: No

Update or Correct Profile

Mailing Address

805 Century Medical Dr Ste C

Titusville, FL 327962100

Phone: 3212686868

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

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