Provider Demographics
NPI:1700844347
Name:OVERMAN, MARK D (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:D
Last Name:OVERMAN
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:1901 HAVERFORD AVE
Mailing Address - Street 2:STE 101
Mailing Address - City:SUN CITY CENTER
Mailing Address - State:FL
Mailing Address - Zip Code:33573-5200
Mailing Address - Country:US
Mailing Address - Phone:817-634-9284
Mailing Address - Fax:813-634-4595
Practice Address - Street 1:1901 HAVERFORD AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:SUN CITY CENTER
Practice Address - State:FL
Practice Address - Zip Code:33573-5200
Practice Address - Country:US
Practice Address - Phone:813-634-9284
Practice Address - Fax:813-634-4595
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2018-10-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME0042976207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL53701XMedicare PIN
D56638Medicare UPIN