Organization
FLORIDA MEDICAL CLINIC, LLC
Active
Parent organization
FLORIDA MEDICAL CLINIC, LLC
Other names
Florida Medical Clinic Pathology Lab
Organization subpart
Yes
Provider details
NPI number
Legal business name
FLORIDA MEDICAL CLINIC, LLC
Authorized official
JOE I DELATORRE (CEO)
(813) 780-8440
Entity
Organization
Contact information
Practice address
17401 COMMERCE PARK BLVD STE 108, TAMPA, FL 33647-3507
(813) 782-8311
Mailing address
38135 MARKET SQ, ZEPHYRHILLS, FL 33542-7505
(813) 780-1255
(813) 780-9773
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
207ZP0105X
Clinical Pathology/Laboratory Medicine Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
690006221
RR MEDICARE
FL
01
—
800020546
LICENSE
FL
Enumeration date
04/30/2007
Last updated
02/21/2020
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