MEDICARE: MY TAMPA BAY PEDIATRICS, P.A.

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	208000000X	Pediatrics Physician	ME92726	FL

General Provider Information

NPI Number	:	1558648451
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY TAMPA BAY PEDIATRICS, P.A.

Provider Business Mailing Address
First Line	:	PO BOX 89038
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33689-0400
Country	:	US
Telephone Number	:	813-418-5246
Fax Number	:	813-994-0806

Provider Business Practice Location Address
First Line	:	26907 FOGGY CREEK RD
Second Line	:	STE 102
City	:	WESLEY CHAPEL
State	:	FL
Zip	:	33544-6778
Country	:	US
Telephone Number	:	813-991-7337
Fax Number	:	813-994-0806

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. CARMEN C ALFARO
Credential	:	MD
Telephone Number	:	813-991-7337

Provider Enumeration Date	:	11/07/2011
Last Update Date	:	11/07/2011

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