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General NPI Number Information
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NPI Number | 1275290413
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Entity Type | Organization
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Legal Business Name | EMERGENCE, M.A.T. LLC
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Dates
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Enumeration Date | 11/23/2021
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Last Update Date | 11/23/2021
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Provider Practice Location Address
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Address Line | 13139 W. LINEBAUGH AVE. UNIT 1
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City | TAMPA
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State | FL
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Zip | 33626
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Country | US
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Telephone | 813-328-4120
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Fax | 813-328-4003
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Provider Business Mailing Address
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Address Line | 13139 W. LINEBAUGH AVE. UNIT 1
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City | TAMPA
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State | FL
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Zip | 33626
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Country | US
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Telephone | 813-328-4120
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Fax | 813-328-4003
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. MARK ALLAN SELDES
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Credential | M.D.
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Telephone | 813-244-7457
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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 |
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License Number State |
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