Healthcare Provider Details

I. General information

NPI: 1962493361
Provider Name (Legal Business Name): MARK ALLEN BECHTEL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 03/23/2021
Certification Date: 03/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1680 RIBAUT RD
PORT ROYAL SC
29935-2008
US

IV. Provider business mailing address

PO BOX 531797
ATLANTA GA
30353-1797
US

V. Phone/Fax

Practice location:
  • Phone: 843-524-3344
  • Fax: 844-295-9894
Mailing address:
  • Phone: 704-834-2450
  • Fax: 704-671-5331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberTL996
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2006-00859
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: