Individual
WILFRED GRAY IDSTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3001 W DR MARTIN LUTHER KING JR BLVD, TAMPA, FL 33607-6307
(813) 870-4000
Mailing address
PO BOX 550643, TAMPA, FL 33655-0643
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME46450
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
30847
BLUE CROSS OF FLORIDA
FL
Enumeration date
07/16/2006
Last updated
02/21/2008
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