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General NPI Number Information
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NPI Number | 1124421409
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Entity Type | Organization
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Legal Business Name | BAY AREA EMERGENCY PHYSICIANS URGENT CARE LLC
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Dates
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Enumeration Date | 10/01/2014
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Last Update Date | 10/01/2014
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Provider Practice Location Address
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Address Line | 6909 W WATERS AVE
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City | TAMPA
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State | FL
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Zip | 33634-2213
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Country | US
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Telephone | 727-532-1355
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1728
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City | CLEARWATER
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State | FL
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Zip | 33757-1728
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Country | US
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Telephone | 727-532-1355
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Fax |
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Authorized Official
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Title or Position | MANAGER
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Name | DAN POLEN
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Credential |
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Telephone | 727-461-8234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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