Provider Demographics
NPI:1699971804
Name:EDWARD B KAMPSEN MD PA
Entity type:Organization
Organization Name:EDWARD B KAMPSEN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-877-2685
Mailing Address - Street 1:2835 W. DE LEON ST.
Mailing Address - Street 2:#202
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33609
Mailing Address - Country:US
Mailing Address - Phone:813-877-2685
Mailing Address - Fax:813-876-5872
Practice Address - Street 1:2835 W DE LEON ST
Practice Address - Street 2:#202
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33609-4130
Practice Address - Country:US
Practice Address - Phone:813-877-2685
Practice Address - Fax:813-876-5872
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL30250OtherBLUE CROSS BLUE SHIELD