Healthcare Provider Details

I. General information

NPI: 1548448129
Provider Name (Legal Business Name): MEDICAL SPECIALIST OF TAMPABAY,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2008
Last Update Date: 02/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13117 66TH ST
LARGO FL
33773-1812
US

IV. Provider business mailing address

13117 66TH ST
LARGO FL
33773-1812
US

V. Phone/Fax

Practice location:
  • Phone: 727-535-7128
  • Fax: 727-535-4071
Mailing address:
  • Phone: 727-535-7128
  • Fax: 727-535-4071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License NumberOS7727
License Number StateFL

VIII. Authorized Official

Name: MR. DAVID KELLY
Title or Position: CLINIC MANAGER
Credential:
Phone: 727-535-7128