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General NPI Number Information
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NPI Number | 1376609891
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Entity Type | Organization
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Legal Business Name | PLANT CITY PEDIATRICS, PA
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Dates
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Enumeration Date | 12/29/2006
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Last Update Date | 10/15/2015
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Provider Practice Location Address
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Address Line | 2370 WALDEN WOODS DR SUITE A
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City | PLANT CITY
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State | FL
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Zip | 33563-7027
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Country | US
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Telephone | 813-659-9800
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Fax | 813-659-9807
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Provider Business Mailing Address
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Address Line | 2370 WALDEN WOODS DR SUITE A
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City | PLANT CITY
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State | FL
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Zip | 33563-7027
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Country | US
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Telephone | 813-659-9800
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Fax | 813-659-9807
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | MS. MARY C KIFER
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Credential |
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Telephone | 813-659-9800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | OS7802
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License Number State | FL
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