Basic Information
| Provider Information | |||||||||
| NPI: | 1720494024 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | FOCUS-FL 1012 PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 510 LORNA SQ | ||||||||
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| City: | HOOVER | ||||||||
| State: | AL | ||||||||
| PostalCode: | 352165480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8772253542 | ||||||||
| FaxNumber: | 8776389903 | ||||||||
| Practice Location | |||||||||
| Address1: | 1501 S DALE MABRY HWY STE A6 | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336295837 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8772253542 | ||||||||
| FaxNumber: | 8776389903 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2014 | ||||||||
| LastUpdateDate: | 07/08/2014 | ||||||||
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| AuthorizedOfficialLastName: | HARDIN | ||||||||
| AuthorizedOfficialFirstName: | REGINA | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 8882253542 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080A0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Adolescent Medicine |
No ID Information.