Organization
ROGER C. BRAINARD, MD, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TINA R PENROD (BILLING MANAGER)
(813) 876-2324
Entity
Organization
Contact information
Practice address
3006 W AZEELE ST, TAMPA, FL 33609-3139
(813) 874-3006
(813) 876-6258
Mailing address
3006 W AZEELE ST, TAMPA, FL 33609-3139
(813) 874-3006
(813) 876-6258
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
ME34885
FL
Other
Enumeration date
07/06/2010
Last updated
07/06/2010
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