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General NPI Number Information
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NPI Number | 1265972103
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Entity Type | Organization
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Legal Business Name | HEALTHY BODIES MEDICAL CENTER
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Dates
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Enumeration Date | 02/25/2017
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Last Update Date | 02/25/2017
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Provider Practice Location Address
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Address Line | 3415 BROOK CROSSING DR
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City | BRANDON
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State | FL
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Zip | 33511-8181
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Country | US
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Telephone | 813-540-5005
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 484
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City | THONOTOSASSA
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State | FL
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Zip | 33592-0484
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | WATSON DUCATEL
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Credential | D.O.
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Telephone | 813-540-5005
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | OS11874
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License Number State | FL
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