Organization
UNITED STATES COAST GUARD
Active
Organization
UNITED STATES COAST GUARD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TODD CHRISTOPHER WILSON (HEALTH SERVICE PETTY OFFICER)
(727) 535-1437
Entity
Organization
Contact information
Practice address
7520 TRANSOM CT, TAMPA, FL 33607-5863
(727) 535-1437
(727) 535-4190
Mailing address
15100 RESCUE WAY, CLEARWATER, FL 33762-2990
(727) 535-1437
(727) 535-4190
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Enumeration date
02/20/2007
Last updated
08/22/2020
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