Provider Demographics
NPI:1255620084
Name:MEHURON, SARAH D (MD)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:D
Last Name:MEHURON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11663 COUNTRYWAY BLVD
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33626-2739
Mailing Address - Country:US
Mailing Address - Phone:813-891-6310
Mailing Address - Fax:813-891-6889
Practice Address - Street 1:11663 COUNTRYWAY BLVD
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33626-2739
Practice Address - Country:US
Practice Address - Phone:813-891-6310
Practice Address - Fax:813-891-6889
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-01
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN15490207Q00000X
FLME112054207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHP322ZMedicare PIN