Healthcare Provider Details

I. General information

NPI: 1801058250
Provider Name (Legal Business Name): DEMIAN OBREGON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2008
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10014 N DALE MABRY HWY STE 217
TAMPA FL
33618-4426
US

IV. Provider business mailing address

10014 N DALE MABRY HWY STE 217
TAMPA FL
33618-4426
US

V. Phone/Fax

Practice location:
  • Phone: 813-981-1671
  • Fax: 813-851-5013
Mailing address:
  • Phone: 813-981-1671
  • Fax: 813-851-5013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberME110697
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberME110687
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: