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NPI Code Detail

MEDICARE: DOCTORS DIET PROGRAM OF SOUTH FLORIDAPLLC

MEDICARE: DOCTORS DIET PROGRAM OF SOUTH FLORIDAPLLC
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
1261Q00000XClinic/Center

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1L652453703740OTHERFLDRIVERS LIC

General Provider Information

NPI Number : 1043718034
Entity Type Code : Organization
Provider Name (Legal Business Name) : DOCTORS DIET PROGRAM OF SOUTH FLORIDAPLLC
Provider Business Mailing Address
First Line : 3345 S DALE MABRY HWY
Second Line :
City : TAMPA
State : FL
Zip : 33629-7817
Country : US
Telephone Number : 813-839-3438
Fax Number :
Provider Business Practice Location Address
First Line : 3345 S DALE MABRY HWY
Second Line :
City : TAMPA
State : FL
Zip : 33629-7817
Country : US
Telephone Number : 813-839-3438
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : JAMES LOWRANCE
Credential :
Telephone Number : 813-839-3438
Provider Enumeration Date : 01/25/2018
Last Update Date : 01/25/2018

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Directions to “DOCTORS DIET PROGRAM OF SOUTH FLORIDAPLLC ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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