Provider Demographics
NPI:1265824171
Name:EMMANUEL MOMPI MD
Entity Type:Organization
Organization Name:EMMANUEL MOMPI MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:MOMPI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-983-0700
Mailing Address - Street 1:341 BULLARD PKWY
Mailing Address - Street 2:
Mailing Address - City:TEMPLE TERRACE
Mailing Address - State:FL
Mailing Address - Zip Code:33617-5544
Mailing Address - Country:US
Mailing Address - Phone:813-983-0700
Mailing Address - Fax:
Practice Address - Street 1:341 BULLARD PKWY
Practice Address - Street 2:
Practice Address - City:TEMPLE TERRACE
Practice Address - State:FL
Practice Address - Zip Code:33617-5544
Practice Address - Country:US
Practice Address - Phone:813-983-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74183207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty