Healthcare Provider Details

I. General information

NPI: 1194714758
Provider Name (Legal Business Name): MARK JEFFREY HEPP MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 10/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 MEASE DR STE 202
SAFETY HARBOR FL
34695-6604
US

IV. Provider business mailing address

455 PINELLAS ST SUITE 400
CLEARWATER FL
33756-3354
US

V. Phone/Fax

Practice location:
  • Phone: 727-725-6246
  • Fax: 727-726-5865
Mailing address:
  • Phone: 727-445-1911
  • Fax: 727-445-1986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License NumberME67936
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: