Provider Demographics
NPI:1780852913
Name:SELBST, MEGAN LEE KATZ (MD)
Entity Type:Individual
Prefix:DR
First Name:MEGAN
Middle Name:LEE KATZ
Last Name:SELBST
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5751 HOOVER BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33634-5340
Mailing Address - Country:US
Mailing Address - Phone:813-886-8334
Mailing Address - Fax:813-490-7242
Practice Address - Street 1:5751 HOOVER BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-5340
Practice Address - Country:US
Practice Address - Phone:813-886-8334
Practice Address - Fax:813-490-7242
Is Sole Proprietor?:No
Enumeration Date:2008-02-11
Last Update Date:2011-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME105300207ZP0102X, 207ZC0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No207ZC0500XAllopathic & Osteopathic PhysiciansPathologyCytopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL002336700Medicaid
FLDQ925ZMedicare UPIN