Organization
MANJUL DERASARI M.D.,P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MANJUL D DERASARI M.D. (MEDICAL DIRECTOR)
(813) 933-5900
Entity
Organization
Contact information
Practice address
1912 E BUSCH BLVD, TAMPA, FL 33612-8666
(813) 933-5900
(813) 935-9687
Mailing address
1912 E BUSCH BLVD, TAMPA, FL 33612-8666
(813) 933-5900
(813) 935-9687
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME54111
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
064751900
—
FL
01
—
11609
BC BS
FL
01
—
2720607
AETNA
FL
Enumeration date
12/08/2006
Last updated
12/19/2013
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