Healthcare Provider Details

I. General information

NPI: 1376629089
Provider Name (Legal Business Name): TEMPLE TERRACE FAMILY PHYSICANS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 03/05/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13311 N 56TH ST
TAMPA FL
33617-1161
US

IV. Provider business mailing address

13311 N 56TH ST
TAMPA FL
33617-1161
US

V. Phone/Fax

Practice location:
  • Phone: 813-899-2015
  • Fax: 813-987-2700
Mailing address:
  • Phone: 813-899-2015
  • Fax: 813-987-2700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberOS5749
License Number StateFL

VIII. Authorized Official

Name: DR. GEORGE R DAVIS
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 813-899-2015