MEDICARE: DOCTORS FAMILY MEDICAL CENTER INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1043349715
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DOCTORS FAMILY MEDICAL CENTER INC.

Provider Business Mailing Address
First Line	:	5535 MEMORIAL HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-7370
Country	:	US
Telephone Number	:	813-901-0705
Fax Number	:	813-901-0566

Provider Business Practice Location Address
First Line	:	5535 MEMORIAL HWY
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-7370
Country	:	US
Telephone Number	:	813-901-0705
Fax Number	:	813-901-0566

Authorized Official
Title or Position	:	DIRECTOR OF CREDENTIALING
Name	:	MR. KEVIN LAMAR GREEN
Credential	:
Telephone Number	:	813-901-0705

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	08/22/2020

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