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General NPI Number Information
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NPI Number | 1831002088
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Entity Type | Organization
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Legal Business Name | PHYSICIANS ENT OF TAMPA LLC
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Dates
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Enumeration Date | 09/28/2026
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Last Update Date | 09/28/2026
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Provider Practice Location Address
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Address Line | 3905 CRESCENT PARK DR FL 1
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City | RIVERVIEW
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State | FL
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Zip | 33578-3625
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Country | US
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Telephone | 917-742-1682
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Fax |
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Provider Business Mailing Address
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Address Line | 3905 CRESCENT PARK DR FL 1
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City | RIVERVIEW
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State | FL
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Zip | 33578-3625
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Country | US
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Telephone | 917-742-1682
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Fax |
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Authorized Official
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Title or Position | OWNER AND MED DIRECTOR
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Name | JOSEPH DERBYSHIRE
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Credential | DO
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Telephone | 917-742-1682
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number |
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License Number State | NULL
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