Organization
FAWCETT MEDICAL IMAGING PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRUCE BIELFELT MD (PRESIDENT)
(727) 942-5103
Entity
Organization
Contact information
Practice address
21298 OLEAN BLVD, PORT CHARLOTTE, FL 33952-6705
(423) 826-1276
Mailing address
4300 N ACCESS RD, SUITE D, CHATTANOOGA, TN 37415-3812
(423) 826-1276
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
270659800
—
FL
01
—
74912
BCBS FLORIDA
FL
Enumeration date
01/19/2006
Last updated
02/27/2013
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