Organization Name: | BANCROFT MEDICAL |
NPI Number: | 1477942316 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | O'HARA MCKENNA (CO-OWNER) |
Mailing Address: | 2111 W Swann Ave Ste 104 Tampa |
State: | FL US |
Postal Code: | 336062478 |
Phone Number: | 8132535969 |
Fax Number: | 8132535848 |
NPI Enumeration Date: | 01/15/2015 |
NPI Last Update Date: | 01/15/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |