Healthcare Provider Details

I. General information

NPI: 1518914977
Provider Name (Legal Business Name): TAMPA BAY RADIOLOGY ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/30/2006
Last Update Date: 05/11/2020
Certification Date: 05/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

119 OAKFIELD DR
BRANDON FL
33511-5779
US

IV. Provider business mailing address

PO BOX 3381
INDIANAPOLIS IN
46206-3381
US

V. Phone/Fax

Practice location:
  • Phone: 813-681-5551
  • Fax: 813-985-8006
Mailing address:
  • Phone: 866-645-8219
  • Fax: 866-645-8219

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085B0100X
TaxonomyBody Imaging Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0013389/06-00020530
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. GILBERT L DROZDOW
Title or Position: PRESIDENT
Credential: MD
Phone: 954-838-2371