Provider Demographics
NPI:1275290413
Name:EMERGENCE, M.A.T. LLC
Entity Type:Organization
Organization Name:EMERGENCE, M.A.T. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLAN
Authorized Official - Last Name:SELDES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-244-7457
Mailing Address - Street 1:13139 W. LINEBAUGH AVE. UNIT 1
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626
Mailing Address - Country:US
Mailing Address - Phone:813-328-4120
Mailing Address - Fax:813-328-4003
Practice Address - Street 1:13139 W. LINEBAUGH AVE. UNIT 1
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626
Practice Address - Country:US
Practice Address - Phone:813-328-4120
Practice Address - Fax:813-328-4003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-23
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty