Provider Demographics
NPI:1922319227
Name:TBR ANESTHESIA
Entity Type:Organization
Organization Name:TBR ANESTHESIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:E
Authorized Official - Last Name:HALLGREN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-544-1600
Mailing Address - Street 1:8250 BRYAN DAIRY RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33777-1353
Mailing Address - Country:US
Mailing Address - Phone:727-544-1600
Mailing Address - Fax:727-546-9071
Practice Address - Street 1:8250 BRYAN DAIRY RD
Practice Address - Street 2:SUITE 200
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33777-1353
Practice Address - Country:US
Practice Address - Phone:727-544-1600
Practice Address - Fax:727-546-9071
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-01
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty