MEDICARE: MARK BELKNAP MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	J3985	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194708750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK BELKNAP MD

Provider Business Mailing Address
First Line	:	400 VETERANS AVE
Second Line	:	DR. BELKNAP 112
City	:	BILOXI
State	:	MS
Zip	:	39531-2410
Country	:	US
Telephone Number	:	903-926-2071
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 VETERANS AVE
Second Line	:	DR. BELKNAP 112
City	:	BILOXI
State	:	MS
Zip	:	39531-2410
Country	:	US
Telephone Number	:	903-926-2071
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/28/2005
Last Update Date	:	03/14/2012

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