Healthcare Provider Details

I. General information

NPI: 1992123483
Provider Name (Legal Business Name): JEREMY M PRICE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2014
Last Update Date: 07/03/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 E FLETCHER AVE
TAMPA FL
33613-4613
US

IV. Provider business mailing address

4535 DRESSLER RD NW
CANTON OH
44718-2545
US

V. Phone/Fax

Practice location:
  • Phone: 813-971-6000
  • Fax:
Mailing address:
  • Phone: 800-828-0898
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number134413
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: