Healthcare Provider Details

I. General information

NPI: 1861428062
Provider Name (Legal Business Name): AMANOLLAH TABESH MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 02/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7001 N DALE MABRY HWY SUITE # 3
TAMPA FL
33614-3910
US

IV. Provider business mailing address

7001 N DALE MABRY HWY SUITE # 3
TAMPA FL
33614-3910
US

V. Phone/Fax

Practice location:
  • Phone: 813-932-0804
  • Fax: 813-932-8163
Mailing address:
  • Phone: 813-932-0804
  • Fax: 813-932-8163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberME41543
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberME41543
License Number StateFL

VIII. Authorized Official

Name: AMANOLLAH TABESH
Title or Position: DIRECTOR
Credential: MD
Phone: 813-932-0804