Organization
PREMIER OB/GYN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
VICKIE L GONZALEZ (OFFICE MANAGER)
(813) 876-6000
Entity
Organization
Contact information
Practice address
2727 W DR MARTIN LUTHER KING JR BLVD, SUITE 630, TAMPA, FL 33607-6383
(813) 876-6000
(813) 876-0590
Mailing address
2727 W DR MLK JR BLVD, SUITE 630, TAMPA, FL 33607
(813) 876-6000
(813) 876-0590
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
ME 43544
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0615498
—
FL
Enumeration date
02/07/2007
Last updated
01/04/2012
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