Organization
THE REPRODUCTIVE MEDICINE GROUP
Active
Other names
The Reproductive Medicine Group
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN GUY (CHIEF OPERATING OFFICER)
(813) 914-7304
Entity
Organization
Contact information
Practice address
612 MEDICAL CARE DR, BRANDON, FL 33511-5937
(813) 661-9114
Mailing address
5245 E FLETCHER AVE, SUITE 1, TEMPLE TERRACE, FL 33617-1126
(813) 914-7304
(813) 914-7314
Taxonomy
Speciality
Code
Description
License number
State
207VE0102X
Reproductive Endocrinology Physician
Primary
60 909
FL
207VE0102X
Reproductive Endocrinology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10D0290313
CLIA NUMBER OF LAB
FL
01
—
21547
GROUP BCBS NUMBER
FL
01
—
L800006333
FL STATE LICENSE OF LAB
FL
Enumeration date
08/30/2006
Last updated
05/31/2022
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