Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | DS7248 | TN |
NPI | 1629067194 |
---|---|
Provider Name | Dr. Mark F. Hardison |
First Address | Murfreesboro, TN 37130-2468 |
Second Address | Murfreesboro, TN 37130-2468 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U84867 | (02) | TN |