Healthcare Provider Details

I. General information

NPI: 1033776166
Provider Name (Legal Business Name): TAMPA GENERAL MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2019
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3140 S FALKENBURG RD
RIVERVIEW FL
33578-2574
US

IV. Provider business mailing address

PO BOX 1289
TAMPA FL
33601-1289
US

V. Phone/Fax

Practice location:
  • Phone: 813-660-7150
  • Fax: 813-660-6627
Mailing address:
  • Phone: 813-844-3956
  • Fax: 813-844-4712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number
License Number State

VIII. Authorized Official

Name: PETER TRAVIS RIAD CHANG
Title or Position: VP CARE TRANSITIONS
Credential:
Phone: 813-844-3956