Organization
FLORIDA MEDICAL PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. GAUTHAM SAMPATH ADMINISTRATION (ADMINISTRATOR)
(813) 907-0233
Entity
Organization
Contact information
Practice address
19007 BRUCE B. DOWNS BLVD., TAMPA, FL 33647
(813) 907-0233
(813) 907-0064
Mailing address
19007 BRUCE B. DOWNS BLVD., TAMPA, FL 33647
(813) 907-0233
(813) 907-0064
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
208000000X
Pediatrics Physician
Primary
—
—
Other
Enumeration date
05/25/2010
Last updated
05/25/2010
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