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General NPI Number Information
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NPI Number | 1891063509
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Entity Type | Organization
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Legal Business Name | EDWARD D. TRIBUZIO, M.D., P.A.
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Dates
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Enumeration Date | 12/08/2011
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Last Update Date | 12/08/2011
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Provider Practice Location Address
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Address Line | 1340 S 18TH ST SUITE 204
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-4799
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Country | US
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Telephone | 904-261-0643
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Fax |
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Provider Business Mailing Address
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Address Line | 1340 S 18TH ST SUITE 204
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City | FERNANDINA BEACH
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State | FL
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Zip | 32034-4799
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Country | US
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Telephone | 904-261-0643
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Fax |
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Authorized Official
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Title or Position | OWNER/PHYSICIAN
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Name | DR. EDWARD DOMINICK TRIBUZIO
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Credential | M.D.
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Telephone | 904-261-0643
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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 | FLME42515
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License Number State | FL
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