Provider Demographics
NPI:1467473702
Name:TAMPA EAR NOSE & THROAT ASSOCIATES
Entity Type:Organization
Organization Name:TAMPA EAR NOSE & THROAT ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:L
Authorized Official - Last Name:SEPER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-972-3353
Mailing Address - Street 1:3000 MEDICAL PARK DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33613-4680
Mailing Address - Country:US
Mailing Address - Phone:813-972-3353
Mailing Address - Fax:813-978-3667
Practice Address - Street 1:3000 MEDICAL PARK DR
Practice Address - Street 2:SUITE 200
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33613-4680
Practice Address - Country:US
Practice Address - Phone:813-972-3353
Practice Address - Fax:813-978-3667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2014-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0056228207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL253992600Medicaid
FL253992600Medicaid