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General NPI Number Information
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NPI Number | 1982816716
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Entity Type | Organization
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Legal Business Name | ASTHMA ALLERGY AND IMMUNOLOGY OF TAMPA BAY PA
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 05/16/2012
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Provider Practice Location Address
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Address Line | 1918 W MARTIN L KING JR BLVD
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City | TAMPA
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State | FL
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Zip | 33607-6510
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Country | US
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Telephone | 813-873-1177
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Fax | 813-873-1166
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Provider Business Mailing Address
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Address Line | 1918 WEST MARTIN LUTHER KING JR. BLVD
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City | TAMPA
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State | FL
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Zip | 33607-6504
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Country | US
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Telephone | 813-873-1177
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Fax | 813-873-1166
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Authorized Official
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Title or Position | PRESIDENT
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Name | DIANA PATRICIA MARTIN
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Credential | M.D.
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Telephone | 813-873-1177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | ME88573
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License Number State | FL
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