Healthcare Provider Details

I. General information

NPI: 1326002627
Provider Name (Legal Business Name): MARK LAVERN MESSINGHAM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9912 LITTLE RD
NEW PORT RICHEY FL
34654-3419
US

IV. Provider business mailing address

17815 HICKORY MOSS PL
TAMPA FL
33647-2285
US

V. Phone/Fax

Practice location:
  • Phone: 727-869-4100
  • Fax:
Mailing address:
  • Phone: 813-973-8697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberM25811
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: