Provider Demographics
NPI:1811216286
Name:FLORIDA MEDICAL PRACTICE
Entity Type:Organization
Organization Name:FLORIDA MEDICAL PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:GAUTHAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMPATH
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATION
Authorized Official - Phone:813-907-0233
Mailing Address - Street 1:19007 BRUCE B. DOWNS BLVD.
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33647
Mailing Address - Country:US
Mailing Address - Phone:813-907-0233
Mailing Address - Fax:813-907-0064
Practice Address - Street 1:19007 BRUCE B. DOWNS BLVD.
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33647
Practice Address - Country:US
Practice Address - Phone:813-907-0233
Practice Address - Fax:813-907-0064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-25
Last Update Date:2010-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty