1376592956 NPI number — DR. FRANK D DEMERY MD

Table of content: DR. FRANK D DEMERY MD (NPI 1376592956)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376592956 NPI number — DR. FRANK D DEMERY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DEMERY
Provider First Name:
FRANK
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1376592956
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10111 WILSKY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33625
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-961-2222
Provider Business Mailing Address Fax Number:
813-961-2220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10111 WILSKY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TAMPA
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-961-2222
Provider Business Practice Location Address Fax Number:
813-961-2220
Provider Enumeration Date:
05/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  ME82542 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2080A0000X , with the licence number: ME87304 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: ME82542 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 456279 . This is a "AETNA-PEDIATRICS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 916506 . This is a "USA HEALTH NET" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 267055100 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 188446 . This is a "A,MERIGROUP" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 224476 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 224476 . This is a "HEALTHEASE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 22476 . This is a "STAYWELL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 06600 . This is a "UNIVERSAL HEALTH CARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 290718 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 10003701 . This is a "CITRUS HEALTH" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 2107757 . This is a "FIRST HEALTH NETWORK" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 360122 . This is a "AETNA-ADULT" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 5827779 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 0410089 . This is a "MEDICARE COMPLETE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 81200 . This is a "BLUE CROSS/BLUE SHIELD FL" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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