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General NPI Number Information
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NPI Number | 1548448129
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Entity Type | Organization
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Legal Business Name | MEDICAL SPECIALIST OF TAMPABAY,LLC
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Dates
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Enumeration Date | 02/05/2008
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Last Update Date | 02/05/2008
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Provider Practice Location Address
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Address Line | 13117 66TH ST
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City | LARGO
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State | FL
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Zip | 33773-1812
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Country | US
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Telephone | 727-535-7128
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Fax | 727-535-4071
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Provider Business Mailing Address
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Address Line | 13117 66TH ST
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City | LARGO
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State | FL
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Zip | 33773-1812
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Country | US
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Telephone | 727-535-7128
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Fax | 727-535-4071
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Authorized Official
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Title or Position | CLINIC MANAGER
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Name | MR. DAVID KELLY
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Credential |
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Telephone | 727-535-7128
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | OS7727
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License Number State | FL
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