MEDICARE: MR. FELIX JOSEPH SUBERVI III PH.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
1	103TC0700X	Clinical Psychologist	PY5313	FL

General Provider Information

NPI Number	:	1750429965
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. FELIX JOSEPH SUBERVI III PH.D.

Provider Business Mailing Address
First Line	:	201 N MACDILL AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-1523
Country	:	US
Telephone Number	:	813-876-1832
Fax Number	:	813-876-0133

Provider Business Practice Location Address
First Line	:	201 N MACDILL AVE
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33609-1523
Country	:	US
Telephone Number	:	813-876-1832
Fax Number	:	813-876-0133

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2007
Last Update Date	:	07/08/2007

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