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Organization
MTM SPECIALIST
Active
Organization
MTM SPECIALIST
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK BYINGTON (MANAGER)
(850) 591-9694
Entity
Organization
Contact information
Practice address
123 J HARVEY ETHRIDGE ST, BONIFAY, FL 32425-2104
(850) 591-9694
Mailing address
1423 CONSERVANCY DR E, TALLAHASSEE, FL 32312-6772
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
3336C0002X
Clinic Pharmacy
—
—
Other
Enumeration date
07/27/2022
Last updated
03/08/2023
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