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General NPI Number Information
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NPI Number | 1861298218
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Entity Type | Organization
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Legal Business Name | MDSIDE
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Dates
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Enumeration Date | 02/24/2025
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 109 N 12TH ST STE 1105
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City | TAMPA
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State | FL
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Zip | 33602-3686
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Country | US
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Telephone | 813-808-3142
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Fax | 813-591-4522
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Provider Business Mailing Address
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Address Line | 401 E JACKSON ST STE 2340-K14
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City | TAMPA
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State | FL
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Zip | 33602-5233
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Country | US
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Telephone | 800-579-6971
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Fax |
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. VICTOR DAMASO CRUZ
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Credential | MD
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Telephone | 813-808-3142
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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