| NPI | 1649827577 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DENNIS MICHAEL IPOCK Manager 813-999-0505 |
| Organization Subpart ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine |
| Additional Taxonomies | 207R00000X Internal Medicine |
| 261QP2300X Clinic/Center, Primary Care | |
| 261QU0200X Clinic/Center, Urgent Care | |
| 332900000X Non-Pharmacy Dispensing Site | |
| Enumeration Date | 2019-08-26 |
| Last Update Date | 2022-04-11 |