MEDICARE: OSTEOPOROSIS AND RHEUMATOLOGY CENTER OF TAMPA BAY LLC

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	174400000X	Specialist	ME27032	FL

General Provider Information

NPI Number	:	1467507202
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OSTEOPOROSIS AND RHEUMATOLOGY CENTER OF TAMPA BAY LLC

Provider Business Mailing Address
First Line	:	3218 W AZEELE ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3018
Country	:	US
Telephone Number	:	813-879-1188
Fax Number	:	813-849-0953

Provider Business Practice Location Address
First Line	:	3218 W AZEELE ST
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-3018
Country	:	US
Telephone Number	:	813-879-1188
Fax Number	:	813-849-0953

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEFFREY L MILLER
Credential	:	MD
Telephone Number	:	813-879-1188

Provider Enumeration Date	:	01/24/2007
Last Update Date	:	05/04/2011

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