Registry details
Type
Individual
Primary specialty
Internal Medicine
Enumerated
Jun 26, 2017
License(s)
ME150742 (FL)
Addresses on file
| Purpose | Address | City/State | Phone |
|---|---|---|---|
| MAILING | PO BOX 198441 | Atlanta, GA 30384-8441 | 813-745-4673 |
| LOCATION | 12902 USF MAGNOLIA DR | Tampa, FL 33612-9416 | 813-745-4673 |
Watch this provider
Get a webhook/email the day this provider is added to the OIG-LEIE exclusion list or appears in an FDA enforcement action.