MEDICARE: MARK D OVERMAN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	ME0042976	FL

General Provider Information

NPI Number	:	1700844347
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK D OVERMAN M.D.

Provider Business Mailing Address
First Line	:	1901 HAVERFORD AVE
Second Line	:	STE 101
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-5200
Country	:	US
Telephone Number	:	817-634-9284
Fax Number	:	813-634-4595

Provider Business Practice Location Address
First Line	:	1901 HAVERFORD AVE
Second Line	:	SUITE 101
City	:	SUN CITY CENTER
State	:	FL
Zip	:	33573-5200
Country	:	US
Telephone Number	:	813-634-9284
Fax Number	:	813-634-4595

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	10/11/2018

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