Organization
SOUTHEAST RADIOLOGY PARTNERS LTD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN R DETELICH (CEO)
(850) 878-4127
Entity
Organization
Contact information
Practice address
1600 PHILLIPS RD, TALLAHASSEE, FL 32308-5304
(316) 685-2371
Mailing address
PO BOX 25335, TAMPA, FL 33622-5335
Taxonomy
Speciality
Code
Description
License number
State
2085R0204X
Vascular & Interventional Radiology Physician
Primary
—
—
Other
Enumeration date
10/21/2022
Last updated
10/21/2022
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