Provider Demographics
NPI:1124407333
Name:TAMPA ORTHOPAEDIC & SPORTS MEDICINE GROUP
Entity Type:Organization
Organization Name:TAMPA ORTHOPAEDIC & SPORTS MEDICINE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DISPENSING PRACTITONER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MURPHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-253-2406
Mailing Address - Street 1:602 S HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-2413
Mailing Address - Country:US
Mailing Address - Phone:813-253-2406
Mailing Address - Fax:
Practice Address - Street 1:602 S HOWARD AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2413
Practice Address - Country:US
Practice Address - Phone:813-253-2406
Practice Address - Fax:813-251-4290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-20
Last Update Date:2015-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0067644332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site