Provider Demographics
NPI:1962494815
Name:DOLGIN, SANFORD R (MD)
Entity Type:Individual
Prefix:DR
First Name:SANFORD
Middle Name:R
Last Name:DOLGIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:SELECT PHYSICIANS ALLIANCE
Mailing Address - Street 2:10002 PRINCESS PALM AVE. STE 332
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33619-8327
Mailing Address - Country:US
Mailing Address - Phone:813-571-7184
Mailing Address - Fax:813-654-4695
Practice Address - Street 1:SUNCOAST ENT SURGICAL SPECIALISTS
Practice Address - Street 2:4714 N ARMENIA AVE. STE 200
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-2603
Practice Address - Country:US
Practice Address - Phone:813-872-8794
Practice Address - Fax:813-879-1652
Is Sole Proprietor?:No
Enumeration Date:2005-08-17
Last Update Date:2019-05-03
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Provider Licenses
StateLicense IDTaxonomies
FLME0060810174400000X, 207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL251793100Medicaid
FLF02589Medicare UPIN