Organization
TAMARAC PATHOLOGY GROUP PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FERNANDO A ESCLOPIS MD, FCAP (PRESIDENT)
(352) 795-8372
Entity
Organization
Contact information
Practice address
6201 N SUNCOAST BLVD, DEPARTMENT OF PATHOLOGY, CRYSTAL RIVER, FL 34428-6712
(352) 795-8372
Mailing address
PO BOX 2030, HOMOSASSA SPRINGS, FL 34447-2030
(352) 621-3100
(352) 621-3121
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
272974100
—
FL
01
—
94803
BLUE CROSS BLUE SHIELD
FL
01
—
DE4684
RAILROAD MEDICARE
—
Enumeration date
03/31/2006
Last updated
03/06/2019
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