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General NPI Number Information
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NPI Number | 1346212370
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Entity Type | Organization
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Legal Business Name | BLUESTONE PHYSICIAN SERVICES SOUTHEAST LLC
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Dates
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Enumeration Date | 02/03/2006
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Last Update Date | 02/07/2024
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Provider Practice Location Address
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Address Line | 10150 HIGHLAND MANOR DR STE 205
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City | TAMPA
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State | FL
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Zip | 33610-9727
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Country | US
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Telephone | 813-259-1013
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Fax | 813-254-0396
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Provider Business Mailing Address
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Address Line | 10150 HIGHLAND MANOR DR STE 205
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City | TAMPA
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State | FL
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Zip | 33610-9727
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Country | US
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Telephone | 813-259-1013
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Fax | 813-254-0396
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DIANA BERNARD I
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Credential |
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Telephone | 813-259-1013
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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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