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General NPI Number Information
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NPI Number | 1922319227
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Entity Type | Organization
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Legal Business Name | TBR ANESTHESIA
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Dates
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Enumeration Date | 07/01/2010
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Last Update Date | 07/01/2010
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Provider Practice Location Address
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Address Line | 8250 BRYAN DAIRY RD SUITE 200
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City | LARGO
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State | FL
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Zip | 33777-1353
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Country | US
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Telephone | 727-544-1600
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Fax | 727-546-9071
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Provider Business Mailing Address
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Address Line | 8250 BRYAN DAIRY RD SUITE 200
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City | LARGO
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State | FL
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Zip | 33777-1353
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Country | US
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Telephone | 727-544-1600
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Fax | 727-546-9071
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Authorized Official
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Title or Position | AGENT
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Name | SCOTT E HALLGREN
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Credential | D.O.
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Telephone | 727-544-1600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State | FL
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