=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073339859
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | THE DOCTORS CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/26/2024
-----------------------------------------------------
Last Update Date | 11/26/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 712 53RD AVE E STE C
-----------------------------------------------------
City | BRADENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34203-5827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-755-2456
-----------------------------------------------------
Fax | 877-788-3881
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 712 53RD AVE E STE C
-----------------------------------------------------
City | BRADENTON
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34203-5827
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 941-755-2459
-----------------------------------------------------
Fax | 877-788-3881
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | COO
-----------------------------------------------------
Name | DAVID ROMANELLO
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 352-459-3661
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------