Healthcare Provider Details

I. General information

NPI: 1396179024
Provider Name (Legal Business Name): ALBERT TAWIL, M.D., P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/29/2013
Last Update Date: 08/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

508 S HABANA AVE STE. 360
TAMPA FL
33609-4181
US

IV. Provider business mailing address

508 S HABANA AVE STE. 360
TAMPA FL
33609-4181
US

V. Phone/Fax

Practice location:
  • Phone: 813-876-5548
  • Fax: 813-874-2477
Mailing address:
  • Phone: 813-876-5548
  • Fax: 813-874-2477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberME0010834
License Number StateFL

VIII. Authorized Official

Name: DR. ALBERT TAWIL
Title or Position: PHYSCIAN
Credential: M.D.
Phone: 813-876-5548