Provider Demographics
NPI:1215903398
Name:STERN, DRAKE, ISBELL & ASSOCIATES, PA
Entity type:Organization
Organization Name:STERN, DRAKE, ISBELL & ASSOCIATES, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:BERLET
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-348-6952
Mailing Address - Street 1:PO BOX 403444
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-3444
Mailing Address - Country:US
Mailing Address - Phone:813-348-6952
Mailing Address - Fax:813-348-6999
Practice Address - Street 1:4516 N ARMENIA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33603-2732
Practice Address - Country:US
Practice Address - Phone:813-348-6952
Practice Address - Fax:813-348-6999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-27
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLV2862OtherBC BS OF FLORIDA
FLV3256OtherBC BS OF FLORIDA
FL00748OtherBC BS OF FLORIDA
FLV2863OtherBC BS OF FLORIDA
FL056471100Medicaid
FLCI3708OtherRR MEDICARE
FLV3256OtherBC BS OF FLORIDA