=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831466903
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | LIMBA J PANSARA MD PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/17/2011
-----------------------------------------------------
Last Update Date | 11/17/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3304 E GIDDENS AVE
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33610-5130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-238-9111
-----------------------------------------------------
Fax | 813-239-9111
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3304 E GIDDENS AVE
-----------------------------------------------------
City | TAMPA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33610-5130
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 813-238-9111
-----------------------------------------------------
Fax | 813-239-9111
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. LIMBA J PANSARA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 813-238-9111
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | 46533
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------