Healthcare Provider Details

I. General information

NPI: 1720067192
Provider Name (Legal Business Name): MEDICAL ASSOCIATES OF WEST FL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 04/03/2024
Certification Date: 04/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 STATE ROAD 52
BAYONET POINT FL
34667-6716
US

IV. Provider business mailing address

7575 STATE ROAD 52
BAYONET POINT FL
34667-6716
US

V. Phone/Fax

Practice location:
  • Phone: 727-861-9800
  • Fax: 727-868-6795
Mailing address:
  • Phone: 727-861-9800
  • Fax: 727-868-6795

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MRS. DANIELLE BOSSE
Title or Position: OFFICE MANAGER
Credential:
Phone: 727-861-9800