Provider Demographics
NPI:1275840084
Name:MARK T HOWELL DO PA
Entity Type:Organization
Organization Name:MARK T HOWELL DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:T
Authorized Official - Last Name:HOWELL
Authorized Official - Suffix:
Authorized Official - Credentials:DO PA
Authorized Official - Phone:813-890-8004
Mailing Address - Street 1:5651 49TH ST N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33709-2105
Mailing Address - Country:US
Mailing Address - Phone:727-520-0615
Mailing Address - Fax:727-520-8457
Practice Address - Street 1:5651 49TH ST N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33709-2105
Practice Address - Country:US
Practice Address - Phone:727-520-0615
Practice Address - Fax:727-520-8457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0007044207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL252416300Medicaid