Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0505X | Family Doctor - Adult Medicine | M25811 | MN |
NPI | 1326002627 |
---|---|
Provider Name | Mark Lavern Messingham |
First Address | Tampa, FL 33647-2285 |
Second Address | New Port Richey, FL 34654-3419 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2006 |
Last Update Date | 08/07/2007 |