Provider Demographics
NPI:1265414775
Name:ROUNTREE, MARK ANDREW (PA)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANDREW
Last Name:ROUNTREE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Last Name:
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Mailing Address - Street 1:113 BRACKISH PL
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-3220
Mailing Address - Country:US
Mailing Address - Phone:701-240-4191
Mailing Address - Fax:
Practice Address - Street 1:113 BRACKISH PL
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-3220
Practice Address - Country:US
Practice Address - Phone:701-240-4191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2014-04-11
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant