Organization
VALRICO MEDICAL CLINIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SYDNEY SHAW (OFFICE MANAGER)
(813) 643-3242
Entity
Organization
Contact information
Practice address
3119 LITHIA PINECREST RD, VALRICO, FL 33596-5632
(813) 643-3242
Mailing address
3119 LITHIA PINECREST RD, VALRICO, FL 33596-5632
(813) 643-3242
Taxonomy
Speciality
Code
Description
License number
State
173000000X
Legal Medicine
Primary
ME83318
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
13136
BCBS GROUP NUMBER
FL
Enumeration date
09/27/2007
Last updated
09/27/2007
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