Healthcare Provider Details

I. General information

NPI: 1881983443
Provider Name (Legal Business Name): DANA M COBERLY, MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 01/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2111 W SWANN AVE SUITE 101
TAMPA FL
33606-2477
US

IV. Provider business mailing address

2111 W SWANN AVE SUITE 101
TAMPA FL
33606-2477
US

V. Phone/Fax

Practice location:
  • Phone: 813-448-6550
  • Fax: 813-448-6511
Mailing address:
  • Phone: 813-448-6550
  • Fax: 813-448-6511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME77633
License Number StateFL

VIII. Authorized Official

Name: DR. DANA M COBERLY
Title or Position: PRESIDENT
Credential: MD
Phone: 813-448-6550