=====================================================
General NPI Number Information
=====================================================
NPI Number | 1538413166
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARK S HARBER MD LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/05/2012
-----------------------------------------------------
Last Update Date | 11/14/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 600 JOHN SIMS PKWY E
-----------------------------------------------------
City | NICEVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32578-2030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-729-8050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 600 JOHN SIMS PKWY E
-----------------------------------------------------
City | NICEVILLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32578-2030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-729-8050
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN
-----------------------------------------------------
Name | DR. MARK STEVEN HARBER
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 850-729-8050
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | ME92190
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------