Healthcare Provider Details

I. General information

NPI: 1689641748
Provider Name (Legal Business Name): BRENDAN CHRISTOPHER O'MALLEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2006
Last Update Date: 07/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13901 BRUCE B DOWNS BLVD
TAMPA FL
33613-3905
US

IV. Provider business mailing address

13901 BRUCE B DOWNS BLVD
TAMPA FL
33613-3905
US

V. Phone/Fax

Practice location:
  • Phone: 813-615-7620
  • Fax: 813-971-7953
Mailing address:
  • Phone: 813-615-7625
  • Fax: 813-971-7953

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number32917
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: