Individual
DR. MARK J TENHOLDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD PA
Contact information
Practice address
1034 MAR WALT DR STE 100, FORT WALTON BEACH, FL 32547-6645
(850) 863-2153
(850) 863-2885
Mailing address
1034 MAR WALT DR UNIT 100, FORT WALTON BEACH, FL 32547-6637
(850) 863-2153
(850) 863-2885
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
ME89699
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
37804
BLUE CROSS BLUE SHIELD FL
FL
05
—
ATN 606147
—
FL
Enumeration date
06/13/2005
Last updated
06/14/2016
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