Healthcare Provider Details

I. General information

NPI: 1043535107
Provider Name (Legal Business Name): DR MARK STEVEN JOSOVITZ, MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2010
Last Update Date: 04/01/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

726 S CHURCH ST
MURFREESBORO TN
37130-4926
US

IV. Provider business mailing address

726 S CHURCH ST
MURFREESBORO TN
37130-4926
US

V. Phone/Fax

Practice location:
  • Phone: 615-893-7786
  • Fax: 615-225-2046
Mailing address:
  • Phone: 615-893-7786
  • Fax: 615-225-2046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number18433
License Number StateTN

VIII. Authorized Official

Name: DR. MARK STEVEN JOSOVITZ
Title or Position: OWNER
Credential: MD
Phone: 615-893-7786