Provider Demographics
NPI:1770571747
Name:TEMPLE, DONALD F (MD)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:F
Last Name:TEMPLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:508 W MARTIN LUTHER KING BLVD
Mailing Address - Street 2:STE A
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33603-3415
Mailing Address - Country:US
Mailing Address - Phone:813-229-1924
Mailing Address - Fax:813-229-3503
Practice Address - Street 1:508 W MARTIN LUTHER KING BLVD
Practice Address - Street 2:STE A
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-3415
Practice Address - Country:US
Practice Address - Phone:813-229-1924
Practice Address - Fax:813-229-3503
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39406174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL066724200Medicaid
FL066724200Medicaid
30496XMedicare PIN
FL593035766OtherEIN