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NPI Code Detail

MEDICARE: MARK HARDIN DO

MEDICARE:   MARK  HARDIN  DO
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
1207Q00000XFamily Medicine PhysicianOS 5218FL

Other Identifiers

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

General Provider Information

NPI Number : 1770544777
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK HARDIN DO
Provider Business Mailing Address
First Line : PO BOX 637
Second Line :
City : ORANGE PARK
State : FL
Zip : 32067-0637
Country : US
Telephone Number : 904-388-3351
Fax Number :
Provider Business Practice Location Address
First Line : 159 N 3RD ST
Second Line :
City : MACCLENNY
State : FL
Zip : 32063-2103
Country : US
Telephone Number : 904-259-7815
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/29/2006
Last Update Date : 10/31/2007

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