Basic Information
| Provider Information | |||||||||
| NPI: | 1508019142 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MACLAREN SPORTS MED INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 18133 PATTERSON RD | ||||||||
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| City: | ODESSA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 335562214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8134961075 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6918 GUNN HWY | ||||||||
| Address2: | STE C | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336253853 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8134961075 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/28/2008 | ||||||||
| LastUpdateDate: | 01/02/2012 | ||||||||
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| AuthorizedOfficialLastName: | MACLAREN | ||||||||
| AuthorizedOfficialFirstName: | MALCOLM | ||||||||
| AuthorizedOfficialMiddleName: | CHRISTOPHER | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 8134961075 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | D.O. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207XP3100X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Pediatric Orthopaedic Surgery | 207XS0106X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Hand Surgery | 207XS0114X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Adult Reconstructive Orthopaedic Surgery | 207XX0004X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Foot and Ankle Surgery | 207XX0005X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Sports Medicine | 207XX0801X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Orthopaedic Trauma | 207X00000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.