# PREMIER OB/GYN

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1174663694
- **Authorized official:** VICKIE L GONZALEZ (OFFICE MANAGER)
- **Authorized official phone:** (813) 876-6000

## Contact information

- **Practice address:** 2727 W DR MARTIN LUTHER KING JR BLVD, SUITE 630, TAMPA, FL 33607-6383
- **Practice address phone:** (813) 876-6000
- **Practice address fax:** (813) 876-0590
- **Mailing address:** 2727 W DR MLK JR BLVD, SUITE 630, TAMPA, FL 33607
- **Mailing address phone:** (813) 876-6000
- **Mailing address fax:** (813) 876-0590

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207V00000X | Obstetrics & Gynecology Physician | ME 43544 | FL | Yes |

## Other

- **Enumeration date:** 02/07/2007
- **Last updated:** 01/04/2012

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 0615498 | — | FL |