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Provider Information for 1346271145

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know


Gender: MALE

Individual NPI: 1346271145

Calendar   Last Updated:  2016-02-09
  Certification Date: 


Name Value
NPI 1346271145
Enumeration Date 2006-07-06
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 14134 NEPHRON LN
HUDSON, FL 34667-6504
United States

Phone: 727-863-5418 | Fax: 727-869-8626
View Map External Link
Primary Practice Address 1055 S FORT HARRISON AVE
CLEARWATER, FL 33756-3905
United States

Phone: 727-442-6245 | Fax: 727-447-3793
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Primary Taxonomy Selected Taxonomy State License Number
Yes 207RN0300X - Internal Medicine Nephrology FL 94479