Basic Information
| Provider Information | |||||||||
| NPI: | 1124159330 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | TOWN & COUNTRY INTERNAL MEDICINE, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 327 | ||||||||
| Address2: | |||||||||
| City: | ODESSA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335560327 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132900422 | ||||||||
| FaxNumber: | 8132900814 | ||||||||
| Practice Location | |||||||||
| Address1: | 6101 WEBB RD | ||||||||
| Address2: | SUITE 104 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336152872 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132900422 | ||||||||
| FaxNumber: | 8132900814 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2007 | ||||||||
| LastUpdateDate: | 10/16/2010 | ||||||||
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| AuthorizedOfficialLastName: | ZLOTO | ||||||||
| AuthorizedOfficialFirstName: | ALAN | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8132900422 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | OS0005001 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 110224184 | 01 | FL | RAILROAD MEDICARE | OTHER |