Individual
DANIEL MBOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
17 DAVIS BLVD STE 504, TAMPA, FL 33606-3475
(813) 259-8783
Mailing address
17 DAVIS BLVD STE 504, TAMPA, FL 33606-3475
(813) 259-8783
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
ME167354
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PS49789
PHARMACIST LICENSE
FL
Enumeration date
02/22/2021
Last updated
08/12/2024
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