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General NPI Number Information
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NPI Number | 1659604122
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Entity Type | Organization
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Legal Business Name | DIABETES WELLNESS CLINICS OF TAMPA BAY
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Dates
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Enumeration Date | 09/15/2009
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Last Update Date | 09/15/2009
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Provider Practice Location Address
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Address Line | 3941 TAMPA RD
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City | OLDSMAR
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State | FL
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Zip | 34677-3104
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Country | US
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Telephone | 813-448-1055
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Fax | 813-448-1057
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Provider Business Mailing Address
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Address Line | 3941 TAMPA RD
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City | OLDSMAR
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State | FL
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Zip | 34677-3104
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Country | US
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Telephone | 813-448-1055
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Fax | 813-448-1057
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RICHARD HENRY DORSEY
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Credential |
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Telephone | 813-448-1055
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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 |
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License Number State |
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