Organization
MPM CARDIOLOGY SERVICES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GLENN D. WATERS (PRESIDENT)
(727) 532-1355
Entity
Organization
Contact information
Practice address
300 PARK PLACE BLVD, SUITE 170, CLEARWATER, FL 33759-4932
(727) 532-0002
(727) 266-4928
Mailing address
PO BOX 9200, PALM HARBOR, FL 34682-9200
(727) 789-3179
(727) 781-1315
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008209100
—
FL
Enumeration date
12/12/2011
Last updated
06/16/2015
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