Provider Demographics
NPI:1962699959
Name:TAMPA BAY PULMONOLOGY PA
Entity type:Organization
Organization Name:TAMPA BAY PULMONOLOGY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:YOUSSEF
Authorized Official - Middle Name:S
Authorized Official - Last Name:ANID
Authorized Official - Suffix:
Authorized Official - Credentials:MD,
Authorized Official - Phone:352-686-2972
Mailing Address - Street 1:11373 CORTEZ BLVD STE 303
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5411
Mailing Address - Country:US
Mailing Address - Phone:352-686-2972
Mailing Address - Fax:352-683-2657
Practice Address - Street 1:11373 CORTEZ BLVD STE 303
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5411
Practice Address - Country:US
Practice Address - Phone:352-686-2972
Practice Address - Fax:352-683-2657
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-03
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME98087207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLF74738Medicare UPIN