Healthcare Provider Details

I. General information

NPI: 1649282039
Provider Name (Legal Business Name): DENNIS FRANCIS BANDYK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 TAMPA GENERAL CIR
TAMPA FL
33606-3603
US

IV. Provider business mailing address

PO BOX 232410
SAN DIEGO CA
92193-2410
US

V. Phone/Fax

Practice location:
  • Phone: 813-259-0929
  • Fax: 813-259-0606
Mailing address:
  • Phone: 619-543-6980
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberME60751
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: