Provider Demographics
NPI:1245098185
Name:SOUTHERN PHYSICIANS GROUP LLC
Entity type:Organization
Organization Name:SOUTHERN PHYSICIANS GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:FINK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:727-677-9333
Mailing Address - Street 1:7045 75TH ST N
Mailing Address - Street 2:
Mailing Address - City:PINELLAS PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33781-3748
Mailing Address - Country:US
Mailing Address - Phone:919-349-1232
Mailing Address - Fax:727-677-9333
Practice Address - Street 1:1609 PASADENA AVE S STE 1E
Practice Address - Street 2:
Practice Address - City:SOUTH PASADENA
Practice Address - State:FL
Practice Address - Zip Code:33707-4555
Practice Address - Country:US
Practice Address - Phone:919-349-1232
Practice Address - Fax:727-677-9333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-06
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No2083P0011XAllopathic & Osteopathic PhysiciansPreventive MedicineUndersea and Hyperbaric MedicineGroup - Multi-Specialty