Provider Demographics
NPI:1528345873
Name:CLINICAL RHEUMATOLOGIST, LLC
Entity type:Organization
Organization Name:CLINICAL RHEUMATOLOGIST, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:LEE CLAY
Authorized Official - Last Name:CLAY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:813-908-5658
Mailing Address - Street 1:8322 N HABANA AVE
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-2819
Mailing Address - Country:US
Mailing Address - Phone:813-908-5658
Mailing Address - Fax:813-908-5067
Practice Address - Street 1:8322 N HABANA AVE
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-2819
Practice Address - Country:US
Practice Address - Phone:813-908-5658
Practice Address - Fax:813-908-5067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-14
Last Update Date:2012-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0007192261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center