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General NPI Number Information
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NPI Number | 1770544777
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Entity Type | Individual
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Provider Name | MARK HARDIN DO
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Gender | Male
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Dates
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Enumeration Date | 03/29/2006
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Last Update Date | 10/31/2007
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Provider Practice Location Address
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Address Line | 159 N 3RD ST
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City | MACCLENNY
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State | FL
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Zip | 32063-2103
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Country | US
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Telephone | 904-259-7815
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 637
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City | ORANGE PARK
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State | FL
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Zip | 32067-0637
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Country | US
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Telephone | 904-388-3351
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS 5218
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License Number State | FL
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