Individual
GERARD THOMAS DORIS III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3409 NOTTINGHAM CT APT 252, TAMPA, FL 33614-4687
(813) 365-2494
Mailing address
3409 NOTTINGHAM CT APT 252, TAMPA, FL 33614-4687
(813) 365-2494
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
83-2319791
—
FL
Enumeration date
12/16/2018
Last updated
12/16/2018
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