Provider Demographics
NPI:1811459563
Name:TAMPA BAY PREMIER OBGYN PLLC
Entity type:Organization
Organization Name:TAMPA BAY PREMIER OBGYN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VICKIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-876-6000
Mailing Address - Street 1:2727 W DR MLK BLVD STE 630
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6399
Mailing Address - Country:US
Mailing Address - Phone:813-876-6000
Mailing Address - Fax:813-872-7459
Practice Address - Street 1:2727 W DR MLK BLVD STE 630
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6399
Practice Address - Country:US
Practice Address - Phone:813-876-6000
Practice Address - Fax:813-872-7459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-02
Last Update Date:2019-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty