Healthcare Provider Details

I. General information

NPI: 1891868972
Provider Name (Legal Business Name): PHYSICIAN'S CHOICE HEARING AND DIZZINESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2006
Last Update Date: 09/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3450 E FLETCHER AVE SUITE 240
TAMPA FL
33613-4655
US

IV. Provider business mailing address

3450 E FLETCHER AVE SUITE 240
TAMPA FL
33613-4655
US

V. Phone/Fax

Practice location:
  • Phone: 813-558-1477
  • Fax:
Mailing address:
  • Phone: 813-558-1477
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number
License Number State

VIII. Authorized Official

Name: JEFF CLARK
Title or Position: PRESIDENT
Credential:
Phone: 813-558-1477