| NPI | 1073735833 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT BRUCE ROSEQUIST Owner 813-948-3838 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: FL 0040424) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL 0048283) |
| 207Q00000X Family Medicine (Licence: FL me20601) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2011-05-04 |