Healthcare Provider Details

I. General information

NPI: 1437348422
Provider Name (Legal Business Name): MONA CAROL MCCULLOUGH M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2007
Last Update Date: 10/19/2021
Certification Date: 10/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6719 GALL BLVD STE 208
ZEPHYRHILLS FL
33542-2569
US

IV. Provider business mailing address

6719 GALL BLVD STE 208
ZEPHYRHILLS FL
33542-2569
US

V. Phone/Fax

Practice location:
  • Phone: 813-782-7318
  • Fax: 813-788-5067
Mailing address:
  • Phone: 813-782-7318
  • Fax: 813-788-5067

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VF0040X
TaxonomyUrogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
License NumberME107055
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: