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Organization
GREATER TAMPA BAY PHYSICIAN NETWORK, LLC
Active
Organization
GREATER TAMPA BAY PHYSICIAN NETWORK, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. WILLIAM TEDERICK JOHNSON (GROUP VICE PRESIDENT/AO)
(615) 372-3375
Entity
Organization
Contact information
Practice address
1615 PASADENA AVE S STE 430, SOUTH PASADENA, FL 33707-4521
(727) 397-0606
(727) 397-6161
Mailing address
PO BOX 742717, ATLANTA, GA 30374-2717
(615) 373-7600
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
207RC0000X
Cardiovascular Disease Physician
—
—
Other
Enumeration date
08/29/2013
Last updated
10/15/2020
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