Healthcare Provider Details

I. General information

NPI: 1013258748
Provider Name (Legal Business Name): TAMPA GENERAL MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/05/2013
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16521 SOUTH U.S. HIGHWAY 301
WIMAUMA FL
33573
US

IV. Provider business mailing address

PO BOX 1289
TAMPA FL
33601-1289
US

V. Phone/Fax

Practice location:
  • Phone: 813-844-4700
  • Fax: 813-844-1976
Mailing address:
  • Phone: 813-844-3956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code163WC3500X
TaxonomyCardiac Rehabilitation Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: DR. PETER T CHANG
Title or Position: CHIEF MEDICAL INFORMATICS OFFICER
Credential: M.D.
Phone: 813-844-3956