Provider Demographics
NPI:1538413166
Name:MARK S HARBER MD LLC
Entity type:Organization
Organization Name:MARK S HARBER MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:HARBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-729-8050
Mailing Address - Street 1:600 JOHN SIMS PKWY E
Mailing Address - Street 2:
Mailing Address - City:NICEVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32578-2030
Mailing Address - Country:US
Mailing Address - Phone:850-729-8050
Mailing Address - Fax:
Practice Address - Street 1:600 JOHN SIMS PKWY E
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-2030
Practice Address - Country:US
Practice Address - Phone:850-729-8050
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-05
Last Update Date:2012-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92190261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care