Provider Demographics
NPI:1679848907
Name:CENTER FOR MEN'S HEALTH - BRANDON
Entity Type:Organization
Organization Name:CENTER FOR MEN'S HEALTH - BRANDON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SLOAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-349-6583
Mailing Address - Street 1:1109 PROFESSIONAL PARK DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4887
Mailing Address - Country:US
Mailing Address - Phone:813-409-2042
Mailing Address - Fax:813-409-2044
Practice Address - Street 1:1109 PROFESSIONAL PARK DR
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4887
Practice Address - Country:US
Practice Address - Phone:813-409-2042
Practice Address - Fax:813-409-2044
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-20
Last Update Date:2012-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39549261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty