Provider Demographics
NPI:1407942790
Name:PRICE, DORA CLAIRE (PAC)
Entity Type:Individual
Prefix:
First Name:DORA
Middle Name:CLAIRE
Last Name:PRICE
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 TAMPA GENERAL CIR
Mailing Address - Street 2:HMT CARDIOLOGY
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33606-3571
Mailing Address - Country:US
Mailing Address - Phone:813-251-0793
Mailing Address - Fax:813-844-1988
Practice Address - Street 1:1 TAMPA GENERAL CIR
Practice Address - Street 2:HMT CARDIOLOGY
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-3571
Practice Address - Country:US
Practice Address - Phone:813-251-0793
Practice Address - Fax:813-844-1988
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9103634363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL005561100Medicaid
FLU7024WMedicare PIN
FLU7024ZMedicare ID - Type Unspecified
FL005561100Medicaid