Organization
CARROLLWOOD EMERGENCY PHYSICIANS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDRE R LANDREVILLE MD (CHIEF OPERATING OFFICER)
(813) 972-4199
Entity
Organization
Contact information
Practice address
7171 N DALE MABRY HWY, TAMPA, FL 33614-2630
(813) 932-2222
(813) 972-5753
Mailing address
12479 TELECOM DR, TAMPA, FL 33637-0913
(813) 972-4199
(813) 972-5753
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
24275
BCBS OF FLORIDA
FL
Enumeration date
05/16/2006
Last updated
11/01/2007
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