Healthcare Provider Details

I. General information

NPI: 1043551344
Provider Name (Legal Business Name): TEAM PHYSICIANS OF FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2013
Last Update Date: 04/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S MISSOURI AVE
CLEARWATER FL
33756-2236
US

IV. Provider business mailing address

1501 S MISSOURI AVE
CLEARWATER FL
33756-2236
US

V. Phone/Fax

Practice location:
  • Phone: 727-488-8044
  • Fax:
Mailing address:
  • Phone: 727-488-8044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111NN0400X
TaxonomyNeurology Chiropractor
License NumberCH10323
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. BENOIT O CHOINIERE
Title or Position: MANAGING MEMBER
Credential: DC
Phone: 727-488-8044