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General NPI Number Information
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NPI Number | 1215988829
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Entity Type | Organization
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Legal Business Name | CARROLLWOOD EMERGENCY PHYSICIANS PA
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 11/01/2007
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Provider Practice Location Address
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Address Line | 7171 N DALE MABRY HWY
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City | TAMPA
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State | FL
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Zip | 33614-2630
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Country | US
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Telephone | 813-932-2222
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Fax | 813-972-5753
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Provider Business Mailing Address
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Address Line | 12479 TELECOM DR
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City | TAMPA
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State | FL
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Zip | 33637-0913
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Country | US
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Telephone | 813-972-4199
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Fax | 813-972-5753
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | DR. ANDRE R LANDREVILLE
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Credential | MD
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Telephone | 813-972-4199
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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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