Provider Demographics
NPI:1811004773
Name:MISTRY, DARSHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DARSHAN
Middle Name:
Last Name:MISTRY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1289
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33601-1289
Mailing Address - Country:US
Mailing Address - Phone:813-660-6400
Mailing Address - Fax:813-660-6699
Practice Address - Street 1:10740 PALM RIVER RD STE 360
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33619
Practice Address - Country:US
Practice Address - Phone:813-660-6400
Practice Address - Fax:813-660-6699
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2018-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-062906207R00000X
FLME136120207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0944689Medicaid
OH0944689Medicaid
F70506Medicare UPIN