Provider Demographics
NPI:1831375112
Name:CLINICAL NEUROSCIENCES OF TAMPA BAY LLP
Entity type:Organization
Organization Name:CLINICAL NEUROSCIENCES OF TAMPA BAY LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:VOLLBRACHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-443-3295
Mailing Address - Street 1:430 MORTON PLANT ST
Mailing Address - Street 2:SUITE 400
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33756-3398
Mailing Address - Country:US
Mailing Address - Phone:727-443-3295
Mailing Address - Fax:727-446-4336
Practice Address - Street 1:430 MORTON PLANT ST
Practice Address - Street 2:SUITE 400
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33756-3398
Practice Address - Country:US
Practice Address - Phone:727-443-3295
Practice Address - Fax:727-446-4336
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-16
Last Update Date:2008-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherEIN