Provider Demographics
NPI:1609101641
Name:PREMIER OB GYN OF TAMPA LLP
Entity type:Organization
Organization Name:PREMIER OB GYN OF TAMPA LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED SIGNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:R
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-876-6000
Mailing Address - Street 1:2727 W DR MLK BLVD
Mailing Address - Street 2:SUITE 630
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33607-6383
Mailing Address - Country:US
Mailing Address - Phone:813-935-8998
Mailing Address - Fax:813-935-0987
Practice Address - Street 1:2727 W DR MLK BLVD
Practice Address - Street 2:SUITE 630
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33607-6383
Practice Address - Country:US
Practice Address - Phone:813-935-8998
Practice Address - Fax:813-935-0987
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-08
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty