Organization
WEST FLORIDA TRAUMA NETWORK, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WILLIAM TEDRICK JOHNSON (GROUP VICE PRESIDENT/AO)
(615) 372-3375
Entity
Organization
Contact information
Practice address
2010 59TH ST W, SUITE 2200, BRADENTON, FL 34209-4616
(813) 453-0590
Mailing address
2000 HEALTH PARK DR, BRENTWOOD, TN 37027-4525
(615) 373-7600
(866) 346-1426
Taxonomy
Speciality
Code
Description
License number
State
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
—
2086S0127X
Trauma Surgery Physician
Primary
—
—
Other
Enumeration date
05/10/2011
Last updated
10/15/2020
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