Basic Information
| Provider Information | |||||||||
| NPI: | 1033243274 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST. PETERSBURG GENERAL SURGERY LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3 MARYLAND FARMS | ||||||||
| Address2: | SUITE 250 | ||||||||
| City: | BRENTWOOD | ||||||||
| State: | TN | ||||||||
| PostalCode: | 370275005 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8006613365 | ||||||||
| FaxNumber: | 8666894661 | ||||||||
| Practice Location | |||||||||
| Address1: | 6450 38TH AVE N | ||||||||
| Address2: | SUITE 410 | ||||||||
| City: | ST PETERSBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337101645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273444200 | ||||||||
| FaxNumber: | 7273444221 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2007 | ||||||||
| LastUpdateDate: | 08/12/2008 | ||||||||
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| AuthorizedOfficialLastName: | DUNCAN | ||||||||
| AuthorizedOfficialFirstName: | GARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | VP | ||||||||
| AuthorizedOfficialTelephone: | 5615481089 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.