Healthcare Provider Details

I. General information

NPI: 1598317810
Provider Name (Legal Business Name): MGROUP PHYSICIAN SERVICES OF FLORIDA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2019
Last Update Date: 07/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1103 GULF WAY
ST PETE BEACH FL
33706-4223
US

IV. Provider business mailing address

1103 GULF WAY
ST PETE BEACH FL
33706-4223
US

V. Phone/Fax

Practice location:
  • Phone: 727-644-3038
  • Fax:
Mailing address:
  • Phone: 727-644-3038
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2083P0011X
TaxonomyUndersea and Hyperbaric Medicine (Preventive Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER ANDREW MORRISON
Title or Position: CEO
Credential: MD
Phone: 727-644-3038