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General NPI Number Information
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NPI Number | 1295927663
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Entity Type | Organization
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Legal Business Name | PHYSICIANS RIGHTPATH LLC
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Dates
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Enumeration Date | 08/09/2007
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Last Update Date | 01/03/2008
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Provider Practice Location Address
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Address Line | 10421 UNIVERSITY CENTER DR 500F
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City | TAMPA
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State | FL
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Zip | 33612-6427
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Country | US
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Telephone | 813-549-1050
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Fax | 813-549-1051
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Provider Business Mailing Address
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Address Line | 10421 UNIVERSITY CENTER DR 500F
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City | TAMPA
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State | FL
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Zip | 33612-6427
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Country | US
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Telephone | 813-549-1050
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Fax | 813-549-1051
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Authorized Official
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Title or Position | PRESIDENT
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Name | DONALD RUSSELL LOCKE
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Credential | M.D.
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Telephone | 352-861-9078
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | PENDING
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License Number State | FL
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