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General NPI Number Information
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NPI Number | 1770971541
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Entity Type | Organization
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Legal Business Name | ST MARY FLORIDA PEDIATRIC CARE PLLC
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Dates
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Enumeration Date | 01/02/2015
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Last Update Date | 10/31/2016
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Provider Practice Location Address
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Address Line | 2626 TAMPA RD STE 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 | 757-754-2868
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Provider Business Mailing Address
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Address Line | 2626 TAMPA RD STE 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 | 757-754-2868
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Authorized Official
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Title or Position | MD/OWNER
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Name | DR. MAGDA F SALIB
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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