Healthcare Provider Details

I. General information

NPI: 1326043936
Provider Name (Legal Business Name): DANA ANN OBZUT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2005
Last Update Date: 07/12/2022
Certification Date: 07/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 W DR MARTIN LUTHER KING JR BLVD
TAMPA FL
33607-7123
US

IV. Provider business mailing address

3001 W DR MLK BLVD
TAMPA FL
33607-6307
US

V. Phone/Fax

Practice location:
  • Phone: 813-870-4824
  • Fax: 813-554-8353
Mailing address:
  • Phone: 813-321-6820
  • Fax: 813-287-6306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License NumberME00000
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: