Healthcare Provider Details

I. General information

NPI: 1659778231
Provider Name (Legal Business Name): ST MARY'S PEDIATRIC CARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2014
Last Update Date: 11/26/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 TAMPA RD SUITE 101
PALM HARBOR FL
34684-3155
US

IV. Provider business mailing address

2626 TAMPA RD SUITE 101
PALM HARBOR FL
34684-3155
US

V. Phone/Fax

Practice location:
  • Phone: 727-754-1984
  • Fax: 727-754-2868
Mailing address:
  • Phone: 727-754-1984
  • Fax: 727-754-2868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME105372
License Number StateFL

VIII. Authorized Official

Name: DR. EID GUIRGUIS
Title or Position: OWNER
Credential: MD
Phone: 727-754-1984