Organization
MOUNTCASTLE VEIN CENTER OF ST PETERSBURG
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DANIEL J MOUNTCASTLE M.D. (PRESIDENT)
(727) 865-6941
Entity
Organization
Contact information
Practice address
5901 SUN BLVD, SUITE 113A, ST PETERSBURG, FL 33715-1166
(727) 865-6941
(727) 864-0929
Mailing address
5901 SUN BLVD, SUITE 201, ST PETERSBURG, FL 33715-1166
(727) 865-6941
(727) 864-0929
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
ME36289
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
039342800
—
FL
01
—
3027OT
MEDICARE
FL
01
—
ME36289
MEDICAL LICENSE NUMBER
FL
Enumeration date
01/25/2007
Last updated
11/20/2014
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