Provider Demographics
NPI:1922431394
Name:CONANT, MARK JR (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:CONANT
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:960 7TH AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33705-1347
Mailing Address - Country:US
Mailing Address - Phone:717-821-8101
Mailing Address - Fax:727-825-1357
Practice Address - Street 1:960 7TH AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33705-3475
Practice Address - Country:US
Practice Address - Phone:727-821-8101
Practice Address - Fax:727-825-1357
Is Sole Proprietor?:No
Enumeration Date:2013-08-20
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME1370242086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL114506200Medicaid