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General NPI Number Information
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NPI Number | 1265434211
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Entity Type | Individual
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Provider Name | MARK STEPHEN MCTAMMANY M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/02/2005
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Last Update Date | 05/18/2021
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Provider Practice Location Address
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Address Line | 1315 VALENTINE ST
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City | MELBOURNE
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State | FL
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Zip | 32901-3127
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Country | US
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Telephone | 321-768-7677
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Fax | 321-768-7756
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Provider Business Mailing Address
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Address Line | 1315 VALENTINE ST
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City | MELBOURNE
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State | FL
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Zip | 32901-3127
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Country | US
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Telephone | 321-344-7677
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Fax | 321-344-7678
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number | ME0072191
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | ME72191
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License Number State | FL
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