Healthcare Provider Details

I. General information

NPI: 1164723250
Provider Name (Legal Business Name): PULMONARY & SLEEP OF TAMPA BAY PL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/05/2010
Last Update Date: 11/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1907 S ALEXANDER ST STE 1
PLANT CITY FL
33566-0921
US

IV. Provider business mailing address

4308 N HABANA AVE
TAMPA FL
33607-6362
US

V. Phone/Fax

Practice location:
  • Phone: 813-654-8100
  • Fax: 813-654-6555
Mailing address:
  • Phone: 813-654-8100
  • Fax: 813-654-6555

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License NumberME89388
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberME89388
License Number StateFL

VIII. Authorized Official

Name: DRAGOS ZANCHI
Title or Position: PRESIDENT
Credential: MD
Phone: 813-654-8100