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General NPI Number Information
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NPI Number | 1477560514
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Entity Type | Organization
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Legal Business Name | SRA VENTURES INC
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Dates
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Enumeration Date | 08/02/2006
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Last Update Date | 07/27/2012
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Provider Practice Location Address
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Address Line | 1193 BLACKWOOD AVE UNIT H
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City | OCOEE
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State | FL
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Zip | 34761-4518
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Country | US
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Telephone | 407-656-6040
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Fax | 407-656-4431
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Provider Business Mailing Address
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Address Line | 501 S LINCOLN AVE #15
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City | CLEARWATER
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State | FL
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Zip | 33756-5945
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Country | US
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Telephone | 727-446-6760
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Fax | 727-441-2465
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Authorized Official
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Title or Position | CEO
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Name | DR. ANTHONY ABOUD
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Credential | DO
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Telephone | 727-446-6760
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State | FL
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