Provider Demographics
NPI:1245532316
Name:VEIN SPECIALISTS OF TAMPA LLC
Entity type:Organization
Organization Name:VEIN SPECIALISTS OF TAMPA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:HOWARD
Authorized Official - Last Name:DWORKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-374-9002
Mailing Address - Street 1:2835 W DE LEON ST STE 102
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609-4130
Mailing Address - Country:US
Mailing Address - Phone:813-374-9002
Mailing Address - Fax:813-374-9093
Practice Address - Street 1:2835 W DE LEON ST
Practice Address - Street 2:SUITE 206
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4130
Practice Address - Country:US
Practice Address - Phone:813-374-9002
Practice Address - Fax:813-374-9093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-23
Last Update Date:2021-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61044208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty