Basic Information
| Provider Information | |||||||||
| NPI: | 1578559753 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | LEOPOLDO GRAUER MD PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3225 S MACDILL AVE | ||||||||
| Address2: | STE 129-300 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336298171 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8134961075 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4600 N HABANA AVE | ||||||||
| Address2: | STE 29 | ||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336147166 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8136738545 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/23/2005 | ||||||||
| LastUpdateDate: | 01/21/2012 | ||||||||
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| AuthorizedOfficialLastName: | GRAUER | ||||||||
| AuthorizedOfficialFirstName: | LEOPOLDO | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 8136738545 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | ME58615 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
No ID Information.