MEDICARE: HARVEY N ESROV MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	D0020505	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1043200538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HARVEY N ESROV MD

Provider Business Mailing Address
First Line	:	2540 GREEN FOREST LN STE 101
Second Line	:
City	:	LUTZ
State	:	FL
Zip	:	33558-5388
Country	:	US
Telephone Number	:	813-920-5200
Fax Number	:	813-920-5228

Provider Business Practice Location Address
First Line	:	11375 CORTEZ BLVD
Second Line	:
City	:	BROOKSVILLE
State	:	FL
Zip	:	34613-5409
Country	:	US
Telephone Number	:	813-920-5200
Fax Number	:	813-920-5228

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/26/2005
Last Update Date	:	10/02/2018

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