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General NPI Number Information
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NPI Number | 1972725414
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Entity Type | Organization
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Legal Business Name | SOUTHEAST RADIOLOGY ASSOCIATES PA
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Dates
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Enumeration Date | 05/03/2007
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Last Update Date | 08/27/2009
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Provider Practice Location Address
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Address Line | 618 VINTAGE WAY
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City | BRANDON
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State | FL
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Zip | 33511-6366
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Country | US
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Telephone | 813-689-8702
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Fax | 813-684-6392
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Provider Business Mailing Address
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Address Line | 618 VINTAGE WAY
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City | BRANDON
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State | FL
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Zip | 33511-6366
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Country | US
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Telephone | 813-689-8702
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Fax | 813-684-6392
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD R SIX
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Credential | M.D.
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Telephone | 813-689-8702
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085D0003X
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Taxonomy Name | Diagnostic Neuroimaging (Radiology) Physician
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License Number |
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License Number State | FL
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