Provider Demographics
NPI:1376629089
Name:TEMPLE TERRACE FAMILY PHYSICANS PA
Entity Type:Organization
Organization Name:TEMPLE TERRACE FAMILY PHYSICANS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:813-899-2015
Mailing Address - Street 1:13311 N 56TH ST
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33617-1161
Mailing Address - Country:US
Mailing Address - Phone:813-899-2015
Mailing Address - Fax:813-987-2700
Practice Address - Street 1:13311 N 56TH ST
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33617-1161
Practice Address - Country:US
Practice Address - Phone:813-899-2015
Practice Address - Fax:813-987-2700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-27
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5749261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDB3650Medicare PIN
FL34460Medicare ID - Type UnspecifiedGROUP NUMBER
FLS66309Medicare UPIN
FLF47300Medicare UPIN