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General NPI Number Information
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NPI Number | 1679387278
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Entity Type | Organization
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Legal Business Name | PIONEER MEDICAL GROUP CLINIC FOUNDATION
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Dates
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Enumeration Date | 02/04/2025
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Last Update Date | 02/04/2025
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Provider Practice Location Address
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Address Line | 3500 E FLETCHER AVE STE 222
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City | TAMPA
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State | FL
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Zip | 33613-4712
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Country | US
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Telephone | 813-450-7231
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Fax | 786-868-0001
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Provider Business Mailing Address
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Address Line | 13067 N TELECOM PKWY
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City | TEMPLE TERRACE
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State | FL
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Zip | 33637-0926
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Country | US
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Telephone | 813-450-7231
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Fax | 786-868-0001
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | MASOOD KHAN
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Credential | MD
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Telephone | 813-943-7784
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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