Basic Information
| Provider Information | |||||||||
| NPI: | 1033512264 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TAMPA OBSTETRICS, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 505 OAKFIELD DR | ||||||||
| Address2: | |||||||||
| City: | BRANDON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335115700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136542273 | ||||||||
| FaxNumber: | 8136541384 | ||||||||
| Practice Location | |||||||||
| Address1: | 4503 NORTH 22ND STREET | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336106201 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136542273 | ||||||||
| FaxNumber: | 8136541384 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2014 | ||||||||
| LastUpdateDate: | 06/01/2015 | ||||||||
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| AuthorizedOfficialLastName: | MAYO | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8136542273 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
ID Information
| ID | Type | State | Issuer | Description | 057571212 | 05 | FL | MEDICAID |