| Organization Name: | MOUNTCASTLE VEIN CENTER OF ST PETERSBURG |
| NPI Number: | 1619022951 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DANIEL J MOUNTCASTLE (PRESIDENT) |
| Mailing Address: | 5901 Sun Blvd Suite 113a St Petersburg |
| State: | FL US |
| Postal Code: | 337151166 |
| Phone Number: | 7278656941 |
| Fax Number: | 7278640929 |
| NPI Enumeration Date: | 01/25/2007 |
| NPI Last Update Date: | 11/20/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | ME36289 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | FL |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |