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Organization
LIVEACTIVE MULTISPECIALTY PHYSICIAN GROUP TAMPA LLC
Active
Organization
LIVEACTIVE MULTISPECIALTY PHYSICIAN GROUP TAMPA LLC
Active
Other names
LiveActive Multispecialty Physician Group Tampa
Organization subpart
No
Provider details
NPI number
Authorized official
SHANE BRETHOWR (CEO/AUTHORIZED OFFICIAL)
(913) 549-3884
Entity
Organization
Contact information
Practice address
12440 CORTEZ BLVD, BROOKSVILLE, FL 34613-2628
(913) 549-3884
Mailing address
PO BOX 1269, BELLEVUE, NE 68005-1269
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
—
—
208M00000X
Hospitalist Physician
Primary
—
—
Other
Enumeration date
01/16/2024
Last updated
09/14/2024
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