Healthcare Provider Details

I. General information

NPI: 1467473702
Provider Name (Legal Business Name): TAMPA EAR NOSE & THROAT ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 04/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 MEDICAL PARK DR SUITE 200
TAMPA FL
33613-4680
US

IV. Provider business mailing address

3000 MEDICAL PARK DR SUITE 200
TAMPA FL
33613-4680
US

V. Phone/Fax

Practice location:
  • Phone: 813-972-3353
  • Fax: 813-978-3667
Mailing address:
  • Phone: 813-972-3353
  • Fax: 813-978-3667

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number0056228
License Number StateFL

VIII. Authorized Official

Name: JANET L. SEPER
Title or Position: PARTNER
Credential: M.D.
Phone: 813-972-3353