Basic Information
| Provider Information | |||||||||
| NPI: | 1386894319 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PLANT CITY INTERNAL MEDICINE SPECIALISTS, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1907 S ALEXANDER ST | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | PLANT CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335638419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137543344 | ||||||||
| FaxNumber: | 8137543574 | ||||||||
| Practice Location | |||||||||
| Address1: | 1907 S ALEXANDER ST | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | PLANT CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335638419 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8137543344 | ||||||||
| FaxNumber: | 8137543574 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2008 | ||||||||
| LastUpdateDate: | 07/16/2010 | ||||||||
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| AuthorizedOfficialLastName: | FYE | ||||||||
| AuthorizedOfficialFirstName: | PEGGY | ||||||||
| AuthorizedOfficialMiddleName: | YVONNE | ||||||||
| AuthorizedOfficialTitleorPosition: | MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8137543344 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.