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Organization

PHYSICIAN ENTERPRISES PL

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. JOHN C BROCK MD (MANAGING MEMBER)
(813) 839-6299
Entity
Organization

Contact information

Practice address
3007 W FAIR OAKS AVE, TAMPA, FL 33611-1640
(813) 839-6299
(813) 839-4939
Mailing address
3007 W FAIR OAKS AVE, TAMPA, FL 33611-1640
(813) 839-6299

Taxonomy

Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
ME41814
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
ME41814
MEDICAL LICENSE
Enumeration date
06/27/2011
Last updated
06/27/2011
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