Organization
MLMG OF FLA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DWAYNE POPE (MANAGING PARTNER)
(843) 812-5988
Entity
Organization
Contact information
Practice address
16578 N DALE MABRY HWY, TAMPA, FL 33618-1325
(843) 812-5988
(877) 903-1383
Mailing address
16578 N DALE MABRY HWY, TAMPA, FL 33618-1325
(843) 812-5988
(877) 903-1383
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
Other
Enumeration date
10/08/2013
Last updated
10/08/2013
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