MEDICARE: MARK JOHN HONOR PA-C

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	363A00000X	Physician Assistant	PA9102161	FL

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	:	1538100359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK JOHN HONOR PA-C

Provider Business Mailing Address
First Line	:	4101 JIM WALTER BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607
Country	:	US
Telephone Number	:	813-745-1600
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 JIM WALTER BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33607-5775
Country	:	US
Telephone Number	:	813-745-1600
Fax Number	:

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

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	08/08/2014

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Directions to “ MARK JOHN HONOR PA-C” Practice Location

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