Organization
STERN, DRAKE, ISBELL AND ASSOCS PA
Active
Organization
STERN, DRAKE, ISBELL AND ASSOCS PA
Active
Other names
SDI Diagnostic Imaging
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JEFF A YOUNGER FACHE (CHIEF EXECUTIVE OFFICER)
(813) 348-6952
Entity
Organization
Contact information
Practice address
4516 N ARMENIA AVE, TAMPA, FL 33603-2732
(813) 348-6950
(813) 348-6999
Mailing address
4516 N ARMENIA AVE, TAMPA, FL 33603-2732
(813) 348-6950
(813) 348-6999
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
2085B0100X
Body Imaging Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
261QR0200X
Radiology Clinic/Center
—
—
261QR0206X
Mammography Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00748
BCBS FLORIDA HBP
FL
05
—
056471100
—
FL
01
—
CI3708
RR MEDICARE
FL
01
—
V2862
BCBS FLORIDA
FL
01
—
V2863
BCBS FLORIDA
FL
01
—
V3256
BCBS FLORIDA
FL
Enumeration date
05/11/2009
Last updated
05/11/2009
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