Provider Demographics
NPI:1144635798
Name:DRIS, MILTON
Entity type:Individual
Prefix:
First Name:MILTON
Middle Name:
Last Name:DRIS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 HENDERSON BLVD
Mailing Address - Street 2:SUITE 405
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33629-5037
Mailing Address - Country:US
Mailing Address - Phone:727-403-2777
Mailing Address - Fax:813-443-2587
Practice Address - Street 1:3825 HENDERSON BLVD
Practice Address - Street 2:SUITE 405
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33629-5037
Practice Address - Country:US
Practice Address - Phone:727-403-2777
Practice Address - Fax:813-443-2587
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLISW-XXXX1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical