Healthcare Provider Details

I. General information

NPI: 1073064127
Provider Name (Legal Business Name): TAMPA GENERAL MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2016
Last Update Date: 12/22/2025
Certification Date: 12/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10740 PALM RIVER ROAD STE 360
TAMPA FL
33619
US

IV. Provider business mailing address

PO BOX 1289
TAMPA FL
33601-1289
US

V. Phone/Fax

Practice location:
  • Phone: 813-660-6000
  • Fax:
Mailing address:
  • Phone: 813-844-3956
  • Fax: 813-844-4712

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. PETER CHANG
Title or Position: CHIEF MEDICAL INFORMATICS OFFICER
Credential: M.D.
Phone: 813-844-3956