Healthcare Provider Details

I. General information

NPI: 1699971804
Provider Name (Legal Business Name): EDWARD B KAMPSEN MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 10/25/2022
Certification Date: 10/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 W DE LEON ST #202
TAMPA FL
33609-4130
US

IV. Provider business mailing address

2835 W. DE LEON ST. #202
TAMPA FL
33609
US

V. Phone/Fax

Practice location:
  • Phone: 813-877-2685
  • Fax: 813-876-5872
Mailing address:
  • Phone: 813-877-2685
  • Fax: 813-876-5872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: CHRISTINA RUBLE
Title or Position: OFFICE ADMIN
Credential:
Phone: 813-877-2685