Organization
BYWATER MENTAL HEALTH PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GERALD LEE RANDALL DO (OWNER)
(727) 371-0079
Entity
Organization
Contact information
Practice address
10225 ULMERTON RD STE 3A, LARGO, FL 33771-3519
(727) 371-0079
Mailing address
10225 ULMERTON RD STE 3A, LARGO, FL 33771-3519
(727) 371-0079
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
—
—
Other
Enumeration date
06/17/2021
Last updated
06/17/2021
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