Healthcare Provider Details

I. General information

NPI: 1023166840
Provider Name (Legal Business Name): DAVID ANDREW MARK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 03/18/2026
Certification Date: 03/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 N CENTER AVE
HARDIN MT
59034-1808
US

IV. Provider business mailing address

402 N CENTER AVE
HARDIN MT
59034-1808
US

V. Phone/Fax

Practice location:
  • Phone: 406-655-4103
  • Fax:
Mailing address:
  • Phone: 406-655-4103
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMED-PHYS-LIC-12540
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number12450
License Number StateMT
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number12450
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: