# MOUNTCASTLE VEIN CENTER OF ST PETERSBURG

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

## Provider details

- **NPI number:** 1619022951
- **Authorized official:** DR. DANIEL J MOUNTCASTLE M.D. (PRESIDENT)
- **Authorized official phone:** (727) 865-6941

## Contact information

- **Practice address:** 5901 SUN BLVD, SUITE 113A, ST PETERSBURG, FL 33715-1166
- **Practice address phone:** (727) 865-6941
- **Practice address fax:** (727) 864-0929
- **Mailing address:** 5901 SUN BLVD, SUITE 201, ST PETERSBURG, FL 33715-1166
- **Mailing address phone:** (727) 865-6941
- **Mailing address fax:** (727) 864-0929

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | ME36289 | FL | Yes |

## Other

- **Enumeration date:** 01/25/2007
- **Last updated:** 11/20/2014

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 039342800 | — | FL |
| 01 | — | 3027OT | MEDICARE | FL |
| 01 | — | ME36289 | MEDICAL LICENSE NUMBER | FL |