Provider Demographics
NPI:1578776274
Name:FRANCISCAN NEUROLOGY CLINIC PA
Entity Type:Organization
Organization Name:FRANCISCAN NEUROLOGY CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-681-8225
Mailing Address - Street 1:8252 DUNHAM STATION DR
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647-3342
Mailing Address - Country:US
Mailing Address - Phone:813-681-8225
Mailing Address - Fax:813-661-9082
Practice Address - Street 1:510 VONDERBURG DR
Practice Address - Street 2:SUITE 3008
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-5980
Practice Address - Country:US
Practice Address - Phone:813-681-8225
Practice Address - Fax:813-661-9082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-08
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME967982084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H92980Medicare UPIN
K15151Medicare ID - Type Unspecified