Individual
WARD G. LONGBOTTOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3100 E FLETCHER AVE, TAMPA, FL 33613-4613
(813) 615-7914
(813) 615-8134
Mailing address
3100 E FLETCHER AVE, TAMPA, FL 33613-4613
(813) 615-7914
(813) 615-8134
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
ME55322
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
050042933
RAILROAD MEDICARE
—
05
—
052605300
—
FL
01
—
11848
BCBS
FL
Enumeration date
11/16/2005
Last updated
10/23/2008
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