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NPI Code Detail

MEDICARE: RUSSELL MERRITTT HOSTETLER M.D.

MEDICARE: RUSSELL MERRITTT HOSTETLER M.D.
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
1207Q00000XFamily Medicine PhysicianME 60537FL
2207Q00000XFamily Medicine PhysicianMD 30287SC
3207Q00000XFamily Medicine PhysicianD0069526MD
4207Q00000XFamily Medicine Physician20137MS

General Provider Information

NPI Number : 1508132762
Entity Type Code : Individual
Provider Name (Legal Business Name) : RUSSELL MERRITTT HOSTETLER M.D.
Provider Business Mailing Address
First Line : 2514 W VIRGINIA AVE
Second Line :
City : TAMPA
State : FL
Zip : 33607-6326
Country : US
Telephone Number : 813-877-1370
Fax Number :
Provider Business Practice Location Address
First Line : 2514 W VIRGINIA AVE
Second Line :
City : TAMPA
State : FL
Zip : 33607-6326
Country : US
Telephone Number : 813-877-1370
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/31/2012
Last Update Date : 03/07/2023

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Directions to “ RUSSELL MERRITTT HOSTETLER M.D.” Practice Location

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