Organization
ADVANCE TAMPA BAY FOOT MEDICAL, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BENJAMIN Q LE DPM (AUTHORIZE OFFICER)
(813) 831-3813
Entity
Organization
Contact information
Practice address
3325 W GANDY BLVD, TAMPA, FL 33611-2931
(813) 831-3813
Mailing address
PO BOX 13485, TAMPA, FL 33681-3485
(813) 831-3813
Taxonomy
Speciality
Code
Description
License number
State
213ES0131X
Foot Surgery Podiatrist
Primary
PO2234
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
007286100
—
FL
Enumeration date
10/09/2012
Last updated
05/11/2017
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