Healthcare Provider Details

I. General information

NPI: 1598134223
Provider Name (Legal Business Name): BRAD BJORNSTAD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/23/2015
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7171 N DALE MABRY HWY
TAMPA FL
33614-2665
US

IV. Provider business mailing address

7171 N DALE MABRY HWY
TAMPA FL
33614-2665
US

V. Phone/Fax

Practice location:
  • Phone: 813-558-8001
  • Fax: 813-558-8011
Mailing address:
  • Phone: 813-558-8001
  • Fax: 813-558-8011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME32599
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: