Healthcare Provider Details

I. General information

NPI: 1629531348
Provider Name (Legal Business Name): WILLIAM BALADRON GUERRA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 06/20/2022
Certification Date: 06/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1989 W LUMSDEN RD
BRANDON FL
33511-8821
US

IV. Provider business mailing address

5130 SUNFOREST DR STE 300
TAMPA FL
33634-6327
US

V. Phone/Fax

Practice location:
  • Phone: 813-653-3111
  • Fax: 813-653-1384
Mailing address:
  • Phone: 727-824-0780
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME155441
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: