Organization
SOUTH TAMPA DERMATOLOGY PL
Active
Other names
South Tampa Dermatology
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JAMES G FLYNN (TREASURER)
(813) 872-9551
Entity
Organization
Contact information
Practice address
2605 W SWANN AVE, SUITE #300, TAMPA, FL 33609-4039
(813) 872-9551
(813) 872-9554
Mailing address
2605 W SWANN AVE, SUITE #300, TAMPA, FL 33609-4039
(813) 872-9551
(813) 872-9554
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME66332
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
26291A
BCBS
FL
Enumeration date
08/22/2006
Last updated
08/22/2020
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