Provider Demographics
NPI:1497850093
Name:HASH, MARK THOMAS (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:THOMAS
Last Name:HASH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2910 KERRY FOREST PKWY # D4-115
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32309-6892
Mailing Address - Country:US
Mailing Address - Phone:850-766-3835
Mailing Address - Fax:229-236-0990
Practice Address - Street 1:3599 UNIVERSITY BLVD SOUTH
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4631
Practice Address - Country:US
Practice Address - Phone:850-766-3835
Practice Address - Fax:229-236-0990
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2025-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5744207Q00000X
FLOS7744207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268637600Medicaid
FL81788XMedicare PIN
FL268637600Medicaid