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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