Organization
GREATER TAMPA BAY PHYSICIAN SPECIALISTS, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM TEDERICK JOHNSON (GROUP VICE PRESIDENT/AO)
(615) 372-5372
Entity
Organization
Contact information
Practice address
602 S AUDUBON AVE, SUITE A, TAMPA, FL 33609-4217
(813) 877-1415
(817) 877-7602
Mailing address
2000 HEALTH PARK DR, BRENTWOOD, TN 37027-4525
(615) 373-7600
(866) 346-1426
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
—
—
2086S0129X
Vascular Surgery Physician
—
—
Other
Enumeration date
08/29/2013
Last updated
10/15/2020
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