Healthcare Provider Details

I. General information

NPI: 1316204258
Provider Name (Legal Business Name): DIRK W. R. SURINGA M.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2012
Last Update Date: 04/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 S HABANA AVE
TAMPA FL
33609-4181
US

IV. Provider business mailing address

508 S HABANA AVE
TAMPA FL
33609-4181
US

V. Phone/Fax

Practice location:
  • Phone: 813-350-0200
  • Fax: 813-350-0890
Mailing address:
  • Phone: 813-350-0200
  • Fax: 813-350-0890

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. MARY COLL
Title or Position: OFFICE MANAGER
Credential:
Phone: 813-350-0200