Organization
DIAGNOSTIC CLINIC MEDICAL GROUP INC.
Active
Other names
Diagnostic Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
GINA MARIE PREBECK (VP OF OPERATIONS)
(727) 581-8767
Entity
Organization
Contact information
Practice address
1301 2ND AVE SW, LARGO, FL 33770-3120
(727) 581-8767
(727) 581-8507
Mailing address
1301 2ND AVE SW, LARGO, FL 33770-3120
(727) 581-8767
(727) 581-8507
Taxonomy
Speciality
Code
Description
License number
State
207K00000X
Allergy & Immunology Physician
—
FL
207L00000X
Anesthesiology Physician
—
FL
207N00000X
Dermatology Physician
—
FL
207Q00000X
Family Medicine Physician
—
FL
207R00000X
Internal Medicine Physician
—
FL
207U00000X
Nuclear Medicine Physician
—
FL
207V00000X
Obstetrics & Gynecology Physician
—
FL
207W00000X
Ophthalmology Physician
—
FL
207X00000X
Orthopaedic Surgery Physician
—
FL
207Y00000X
Otolaryngology Physician
—
FL
207ZC0500X
Cytopathology Physician
—
FL
208000000X
Pediatrics Physician
—
FL
2085U0001X
Diagnostic Ultrasound Physician
—
FL
208600000X
Surgery Physician
—
FL
208800000X
Urology Physician
Primary
—
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
260094300
—
FL
05
—
260094304
—
FL
Enumeration date
06/16/2005
Last updated
07/21/2022
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