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Organization
PIONEER MONONGALIA MEDICAL GROUP PLLC
Active
Organization
PIONEER MONONGALIA MEDICAL GROUP PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JAMES GRIFFITH (BUSINESS MANAGER)
(813) 779-6303
Entity
Organization
Contact information
Practice address
13067 N TELECOM PKWY, TEMPLE TERRACE, FL 33637-0926
(813) 779-6303
Mailing address
13067 N TELECOM PKWY, TEMPLE TERRACE, FL 33637-0926
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
123456789
INTERNAL MEDICINE
—
Enumeration date
12/28/2021
Last updated
12/28/2021
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