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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