Provider Demographics
NPI:1184312878
Name:TAMPA MEDICAL GROUP
Entity type:Organization
Organization Name:TAMPA MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMARRAI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-629-0463
Mailing Address - Street 1:5351 BRIDGE ST UNIT 39
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33611-3425
Mailing Address - Country:US
Mailing Address - Phone:813-629-0463
Mailing Address - Fax:
Practice Address - Street 1:5351 BRIDGE ST UNIT 39
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33611-3425
Practice Address - Country:US
Practice Address - Phone:813-629-0463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-01
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty