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Individual

MR. RORTANA OUM

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
AAC

Contact information

Practice address
3100 E FLETCHER AVE, TAMPA, FL 33613-4613
(813) 615-7848
Mailing address
13560 CYPRESS GLEN LN UNIT 201, TAMPA, FL 33637-1116
(913) 661-4676

Taxonomy

Speciality
Code
Description
License number
State
367H00000X
Anesthesiologist Assistant
Primary
AA68
FL

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
AA68
AAC
FL
Enumeration date
10/22/2010
Last updated
10/22/2010
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