Healthcare Provider Details

I. General information

NPI: 1407861859
Provider Name (Legal Business Name): T CHRISTOPHER WINDHAM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 09/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12902 USF MAGNOLIA DR
TAMPA FL
33612-9416
US

IV. Provider business mailing address

PO BOX 917770
ORLANDO FL
32891-7770
US

V. Phone/Fax

Practice location:
  • Phone: 813-844-7968
  • Fax: 813-844-4049
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberME86972
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: