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General NPI Number Information
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NPI Number | 1679848907
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Entity Type | Organization
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Legal Business Name | CENTER FOR MEN'S HEALTH - BRANDON
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Dates
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Enumeration Date | 03/20/2012
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Last Update Date | 05/09/2012
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Provider Practice Location Address
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Address Line | 1109 PROFESSIONAL PARK DR
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City | BRANDON
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State | FL
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Zip | 33511-4887
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Country | US
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Telephone | 813-409-2042
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Fax | 813-409-2044
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Provider Business Mailing Address
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Address Line | 1109 PROFESSIONAL PARK DR
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City | BRANDON
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State | FL
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Zip | 33511-4887
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Country | US
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Telephone | 813-409-2042
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Fax | 813-409-2044
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Authorized Official
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Title or Position | GROUP ADMINISTRATOR
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Name | MR. PAUL A SLOAN
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Credential |
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Telephone | 941-349-6583
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | ME39549
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License Number State | FL
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