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General NPI Number Information
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NPI Number | 1225403520
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Entity Type | Organization
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Legal Business Name | COMPREHENSIVE ANESTHESIA OF PINELLAS LLC
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Dates
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Enumeration Date | 12/11/2015
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Last Update Date | 12/11/2015
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Provider Practice Location Address
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Address Line | 1988 GULF TO BAY BLVD
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City | CLEARWATER
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State | FL
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Zip | 33765-3550
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Country | US
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Telephone | 813-263-7457
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Fax |
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Provider Business Mailing Address
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Address Line | 16618 VILLALENDA DE AVILA
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City | TAMPA
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State | FL
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Zip | 33613-5200
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Country | US
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Telephone | 813-263-7457
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. RODERICK MORRISON FITZ RANDOLPH
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Credential | MD
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Telephone | 813-263-7457
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | ME47220
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License Number State | FL
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