Healthcare Provider Details

I. General information

NPI: 1699769281
Provider Name (Legal Business Name): HOA V LE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2005
Last Update Date: 04/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5800 49TH ST N SUITE S-204
SAINT PETERSBURG FL
33709-2146
US

IV. Provider business mailing address

5800 49TH ST N SUITE S-204
SAINT PETERSBURG FL
33709-2146
US

V. Phone/Fax

Practice location:
  • Phone: 727-525-0239
  • Fax: 727-525-0807
Mailing address:
  • Phone: 727-525-0239
  • Fax: 727-525-0807

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME90612
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: