Healthcare Provider Details

I. General information

NPI: 1265894034
Provider Name (Legal Business Name): STAR RADIOLOGY OF FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2016
Last Update Date: 01/22/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3870 TAMPA RD
OLDSMAR FL
34677-3133
US

IV. Provider business mailing address

PO BOX 320392
TAMPA FL
33679-2392
US

V. Phone/Fax

Practice location:
  • Phone: 813-369-7827
  • Fax: 813-814-1615
Mailing address:
  • Phone: 813-369-7827
  • Fax: 813-814-1615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME99052
License Number StateFL

VIII. Authorized Official

Name: DR. DWIGHT A TOWNSEND
Title or Position: OWNER
Credential: MD
Phone: 361-548-1249