Healthcare Provider Details

I. General information

NPI: 1467847533
Provider Name (Legal Business Name): LUIZ DE SOUZA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2015
Last Update Date: 09/27/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 BAY PINES BLVD BUILDING 2, ROOM 328
BAY PINES FL
33744
US

IV. Provider business mailing address

10000 BAY PINES BLVD BUILDING 2, ROOM 328
BAY PINES FL
33744
US

V. Phone/Fax

Practice location:
  • Phone: 727-398-6661
  • Fax:
Mailing address:
  • Phone: 727-398-6661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME139824
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: