MEDICARE: HMFMD PLLC DOCTOR DOCTOR PRIMARY CARE SERVICES

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	261QP2000X	Physical Therapy Clinic/Center
2	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1194507921
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HMFMD PLLC DOCTOR DOCTOR PRIMARY CARE SERVICES

Provider Business Mailing Address
First Line	:	PO BOX 75496
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33675-0496
Country	:	US
Telephone Number	:	813-743-4383
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 W. MARTIN LUTHER KING JR. BLVD
Second Line	:	SUITE 4
City	:	TAMPA
State	:	FL
Zip	:	33605-1837
Country	:	US
Telephone Number	:	813-743-4383
Fax Number	:	888-713-4253

Authorized Official
Title or Position	:	MNGR
Name	:	DR. HENRIA M FAIN
Credential	:	MD
Telephone Number	:	813-743-4383

Provider Enumeration Date	:	10/17/2023
Last Update Date	:	02/17/2025

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