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General NPI Number Information
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NPI Number | 1083355846
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Entity Type | Individual
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Provider Name | MICHAEL GENE NIEDERBRACH JR.
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Gender | Male
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Dates
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Enumeration Date | 04/05/2022
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Last Update Date | 08/01/2025
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Provider Practice Location Address
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Address Line | 1800 66TH ST N STE 210
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City | ST PETERSBURG
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State | FL
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Zip | 33710-8747
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Country | US
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Telephone | 727-893-6323
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Fax | 727-893-6324
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Provider Business Mailing Address
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Address Line | 1800 66TH ST N STE 210
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City | ST PETERSBURG
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State | FL
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Zip | 33710-8747
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Country | US
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Telephone | 727-893-6323
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Fax | 727-893-6324
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME168138
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License Number State | FL
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