MEDICARE: WHITAKER,WEINTRAUB & GRIZZARD, MD,PA

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	174400000X	Specialist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CI4733	OTHER	FL	RAILROAD
2	38648	OTHER	FL	BCBS

General Provider Information

NPI Number	:	1699708289
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WHITAKER,WEINTRAUB & GRIZZARD, MD,PA

Provider Business Mailing Address
First Line	:	4108 HENDERSON BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629
Country	:	US
Telephone Number	:	813-289-4410
Fax Number	:	813-247-2949

Provider Business Practice Location Address
First Line	:	4108 HENDERSON BLVD
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33629-5750
Country	:	US
Telephone Number	:	813-289-4410
Fax Number	:	813-247-2949

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JOE E WHITAKER
Credential	:	MD
Telephone Number	:	813-289-4410

Provider Enumeration Date	:	07/08/2006
Last Update Date	:	08/22/2020

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