Healthcare Provider Details

I. General information

NPI: 1295032209
Provider Name (Legal Business Name): PR MEDICAL CENTER PLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/28/2011
Last Update Date: 02/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10750 N 56TH ST
TEMPLE TERRACE FL
33617-3615
US

IV. Provider business mailing address

10750 N 56TH ST
TEMPLE TERRACE FL
33617-3615
US

V. Phone/Fax

Practice location:
  • Phone: 813-988-1500
  • Fax:
Mailing address:
  • Phone: 813-988-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberPMC207
License Number StateFL

VIII. Authorized Official

Name: MR. ELSHAFEY ABDALLAH-ASHOUR
Title or Position: OWNER
Credential:
Phone: 813-988-1500