| Organization Name: | ST.JOHN'S MEDICAL CLINIC,PA |
| NPI Number: | 1508166786 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CHI-SHANG CHEN (OWNER) |
| Mailing Address: | 12001 N Nebraska Ave Tampa |
| State: | FL US |
| Postal Code: | 336125343 |
| Phone Number: | 8139721282 |
| Fax Number: | 8139781677 |
| NPI Enumeration Date: | 10/22/2010 |
| NPI Last Update Date: | 10/22/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | ME41425 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |