Organization
MW WELLNESS XV LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JODI DESPOY (MANAGER)
(813) 228-6334
Entity
Organization
Contact information
Practice address
67 FEDERAL RD STE 100, BROOKFIELD, CT 06804-2539
(813) 228-6334
Mailing address
509 S HYDE PARK AVE, TAMPA, FL 33606-2266
(813) 228-6334
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
207RB0002X
Obesity Medicine (Internal Medicine) Physician
—
—
Other
Enumeration date
12/21/2021
Last updated
06/26/2023
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