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General NPI Number Information
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NPI Number | 1659778231
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Entity Type | Organization
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Legal Business Name | ST MARY'S PEDIATRIC CARE PLLC
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Dates
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Enumeration Date | 11/26/2014
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Last Update Date | 11/26/2014
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Provider Practice Location Address
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Address Line | 2626 TAMPA RD SUITE 101
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City | PALM HARBOR
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State | FL
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Zip | 34684-3155
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Country | US
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Telephone | 727-754-1984
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Fax | 727-754-2868
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Provider Business Mailing Address
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Address Line | 2626 TAMPA RD SUITE 101
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City | PALM HARBOR
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State | FL
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Zip | 34684-3155
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Country | US
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Telephone | 727-754-1984
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Fax | 727-754-2868
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Authorized Official
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Title or Position | OWNER
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Name | DR. EID GUIRGUIS
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Credential | MD
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Telephone | 727-754-1984
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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 | ME105372
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License Number State | FL
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