Healthcare Provider Details

I. General information

NPI: 1902946627
Provider Name (Legal Business Name): THOMAS E ESPOSITO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/08/2007
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 PASADENA AVE S
ST PETERSBURG FL
33707-2128
US

IV. Provider business mailing address

630 PASADENA AVE S
ST PETERSBURG FL
33707-2128
US

V. Phone/Fax

Practice location:
  • Phone: 727-360-1784
  • Fax: 727-360-1823
Mailing address:
  • Phone: 727-360-1784
  • Fax: 727-360-1823

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME60511
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: