Organization
GREATER TAMPA BAY PHYSICIAN SPECIALISTS, LLC
Active
Parent organization
GREATER TAMPA BAY PHYSICIAN SPECIALISTS, LLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
GREATER TAMPA BAY PHYSICIAN SPECIALISTS, LLC
Authorized official
WILLIAM TEDRICK JOHNSON (VICE PRESIDENT)
(615) 372-3375
Entity
Organization
Contact information
Practice address
2010 59TH ST W STE 1500, BRADENTON, FL 34209-4649
(941) 896-4788
Mailing address
2000 HEALTH PARK DR, BRENTWOOD, TN 37027-4692
(615) 372-5426
Taxonomy
Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
—
—
Other
Enumeration date
07/23/2021
Last updated
07/23/2021
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