Individual
DIRK ENTZIAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
100 SOUTH ASHLEY DRIVE, SUITE 1500, TAMPA, FL 33602-5318
(813) 899-6220
(813) 985-8006
Mailing address
100 SOUTH ASHLEY DRIVE, SUITE 1500, TAMPA, FL 33602-5318
(813) 899-6220
(813) 985-8006
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
050160
GA
2085R0202X
Diagnostic Radiology Physician
8048800-1205
UT
2085R0202X
Diagnostic Radiology Physician
M-11566
ID
2085R0202X
Diagnostic Radiology Physician
Primary
ME126598
FL
2085R0204X
Vascular & Interventional Radiology Physician
050160
GA
2085R0204X
Vascular & Interventional Radiology Physician
ME126598
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
20000820
MEDICARE
ID
01
—
U000075283
MEDICARE
UT
Enumeration date
05/04/2006
Last updated
01/29/2016
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