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Diagnostic Radiology >> Radiology >> Allopathic & Osteopathic Physicians

Registrant NPI Number: 1457553075

Individual Registrant:
Gender: M
Not Sole Proprietor

Location and contact information for practice:
20110 GULF BLVD APT 400  INDIAN SHORES, FL 33785-2452 US
Tel: 901-857-0370  Fax: --

Contact information for business:
20110 GULF BLVD APT 400  INDIAN SHORES, FL 33785-2452 US
Tel: 901-857-0370  Fax: --

Registration Information:
NPI: 1457553075
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
N2085R0202XAllopathic & Osteopathic Physicians
Diagnostic Radiology
Y2085R0204XAllopathic & Osteopathic Physicians

Legacy codes, insurance codes and state license numbers:



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