=====================================================
General NPI Number Information
=====================================================
NPI Number | 1437612645
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CAROL MARIE FRALEY MD
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/13/2019
-----------------------------------------------------
Last Update Date | 11/04/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 TAMPA GENERAL CIR
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33606-3571
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-821-8038
-----------------------------------------------------
Fax | 813-974-0483
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7050 SEMINOLE BLVD
-----------------------------------------------------
City | SEMINOLE
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33772-5931
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 727-392-8033
-----------------------------------------------------
Fax | 727-526-4346
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | ME155534
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------