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NPI Code Detail

MEDICARE: BILL FOO M.D.

MEDICARE: BILL FOO 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
1208M00000XHospitalist PhysicianME157305FL
2208000000XPediatrics PhysicianA155650CA
3208000000XPediatrics PhysicianME157305FL

General Provider Information

NPI Number : 1679951347
Entity Type Code : Individual
Provider Name (Legal Business Name) : BILL FOO M.D.
Provider Business Mailing Address
First Line : 720 BROOKER CREEK BLVD STE 215
Second Line :
City : OLDSMAR
State : FL
Zip : 34677-2937
Country : US
Telephone Number : 813-854-2003
Fax Number : 813-436-5378
Provider Business Practice Location Address
First Line : 10729 QUEENS TOWN DR
Second Line :
City : RIVERVIEW
State : FL
Zip : 33579-7186
Country : US
Telephone Number : 813-672-3497
Fax Number : 813-741-2418
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2015
Last Update Date : 10/01/2024

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