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General NPI Number Information
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NPI Number | 1740554971
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Entity Type | Organization
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Legal Business Name | LARRY FISHMAN MD PA
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Dates
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Enumeration Date | 03/06/2012
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Last Update Date | 03/06/2012
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Provider Practice Location Address
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Address Line | 427 S PARSONS AVE SUITE 110
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City | BRANDON
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State | FL
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Zip | 33511-5291
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Country | US
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Telephone | 813-653-2770
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Fax | 813-654-6668
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Provider Business Mailing Address
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Address Line | 427 S PARSONS AVE SUITE 110
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City | BRANDON
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State | FL
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Zip | 33511-5291
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Country | US
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Telephone | 813-653-2770
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Fax | 813-654-6668
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Authorized Official
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Title or Position | PHYSICIAN
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Name | LARRY FISHMAN
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Credential | M.D.
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Telephone | 813-653-2770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number | ME0053007
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License Number State | FL
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