Healthcare Provider Details

I. General information

NPI: 1992569420
Provider Name (Legal Business Name): TAMPA FACE AND BODY, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 02/06/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10860 SHELDON RD
TAMPA FL
33626-5117
US

IV. Provider business mailing address

10860 SHELDON RD
TAMPA FL
33626-5117
US

V. Phone/Fax

Practice location:
  • Phone: 813-355-8412
  • Fax: 813-355-8415
Mailing address:
  • Phone: 813-355-8412
  • Fax: 813-355-8415

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS MCEWAN
Title or Position: OWNER
Credential: MD
Phone: 573-673-8488