Deactivated NPI 1902807365 Deactivated / Inactive NPI Male Practitioner

Dr. George Leslie Bondar , DO

Dermatology • Tampa, FL

Public Directory Information & Medical Disclaimer

This profile is compiled from official public domain records provided by CMS and the NPPES registry. TRUE-MEDINFO is an independent reference directory and does not provide medical advice, diagnosis, or treatment recommendations. Always consult a licensed medical professional for personal health decisions.

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. George Bondar has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date August 09, 2005

NPI Deactivation Date October 16, 2024

Total Practice Duration ~19 Years of Practice (2005 – 2024)

Professional Overview & Biography Verified Profile Summary

Dr. George Bondar, DO was a registered Dermatology practicing in Tampa, FL. Throughout an active medical career spanning 19 years, Dr. Bondar provided care at the practice location at 4200 N ARMENIA AVE until profile deactivation on 2024-10-16.

Historical Medicare Part B clinical services included destruction of precancer skin growth, 2-14 growths, established patient outpatient office visit, destruction of skin growth. Public procedure reimbursement records and service volume details are provided below for historical transparency.

Practice Location & Contact Primary Location

Practice Address

4200 N Armenia Ave
Suite 1

Tampa, FL 336076438

Telephone 8138774811

Fax 8138702851

Associated Practice Facility / Clinic

🏢 Michael A. Scannon Md Pa Facility NPI 1841267895

Specialty Benchmarks & Practice Insights

Comparative analytics for Dermatology in Tampa, FL

Active Practitioner

Practitioner Clinical Experience

Active

City Avg: 23.0 Yrs

State Avg: 23.7 Yrs

Regional Practice Density

49 Specialists

Practicing in Tampa, FL (1273 Statewide)

Telehealth Adoption Rate

4.1% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount

54.7% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Performed Procedures & Service Volume

Top Medicare Part B procedures performed by this practitioner

CMS Official Data (2024)

Reporting Year:

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	517	121	$12.59	$6.36
99213 Established patient office or other outpatient visit, typically 15 minutes	421	340	$178.63	$90.09
17000 Destruction of skin growth	257	184	$131.41	$51.16
11102 Tangential biopsy of single skin lesion	184	158	$193.02	$89.54
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	176	131	$251.80	$126.70
17110 Destruction of up to 14 skin growths	129	112	$218.68	$110.53
11103 Biopsy of related skin growth, each additional growth	82	53	$96.87	$48.41
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	40	36	$110.38	$55.68
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	33	33	$220.44	$111.18
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	29	22	$475.55	$116.48
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	28	21	$826.16	$418.57
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	25	16	$345.74	$143.24
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	17	12	$913.17	$443.51
69100 Biopsy of ear	16	14	$184.86	$55.44
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	13	13	$330.45	$166.43

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	793	164	$12.89	$6.46
99213 Established patient office or other outpatient visit, typically 15 minutes	720	435	$179.25	$89.27
17000 Destruction of skin growth	418	261	$132.47	$49.92
11102 Tangential biopsy of single skin lesion	361	257	$199.12	$89.38
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	243	166	$253.79	$126.88
17110 Destruction of up to 14 skin growths	207	153	$222.35	$109.00
11103 Biopsy of related skin growth, each additional growth	164	94	$99.00	$49.68
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	92	76	$111.84	$55.56
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	72	72	$224.46	$110.55
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	62	42	$485.31	$121.66
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	42	28	$844.23	$423.82
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	39	27	$354.12	$153.18
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	29	26	$939.81	$471.40
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	28	26	$601.42	$290.88
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	25	25	$332.28	$166.95
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	17	16	$531.43	$133.55
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	14	14	$788.36	$395.77
17004 Destruction of precancer skin growth, 15 or more growths	14	14	$334.46	$155.64
11104 Punch biopsy, first skin growth	13	12	$247.66	$124.10

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	851	175	$13.16	$6.59
99213 Established patient office or other outpatient visit, typically 15 minutes	746	451	$181.80	$90.93
17000 Destruction of skin growth	414	268	$134.30	$53.36
11102 Tangential biopsy of single skin lesion	346	249	$203.42	$94.43
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	190	142	$255.94	$126.47
11103 Biopsy of related skin growth, each additional growth	165	88	$101.76	$49.81
17110 Destruction of up to 14 skin growths	122	103	$224.72	$110.03
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	85	70	$113.24	$56.67
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	53	42	$490.00	$123.00
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	51	51	$226.40	$113.30
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	36	27	$857.34	$430.70
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	31	27	$952.44	$478.62
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	26	23	$357.16	$168.44
17004 Destruction of precancer skin growth, 15 or more growths	24	20	$334.86	$167.84
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	24	23	$606.78	$303.51
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	23	21	$539.38	$135.31
11622 Removal of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	20	18	$506.88	$127.27
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	16	13	$784.10	$389.69
69100 Biopsy of ear	15	13	$193.68	$74.38
99204 New patient office or other outpatient visit with moderate level of medical decision making, if using time, 45 minutes or more	14	14	$337.66	$168.91
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	13	12	$801.90	$403.20
10060 Simple or single drainage of skin abscess	12	11	$249.08	$124.60

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,057	175	$12.65	$6.23
99213 Established patient office or other outpatient visit, typically 15 minutes	868	484	$182.67	$91.13
17000 Destruction of skin growth	450	275	$130.89	$50.16
11102 Tangential biopsy of single skin lesion	381	276	$204.77	$93.96
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	139	121	$111.67	$55.84
11103 Biopsy of related skin growth, each additional growth	136	90	$104.77	$50.33
17110 Destruction of up to 14 skin growths	129	103	$223.57	$110.96
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	69	69	$225.58	$112.12
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	67	62	$259.48	$130.50
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	41	34	$494.62	$124.56
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	41	29	$355.76	$161.14
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	30	27	$959.96	$483.40
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	29	25	$869.64	$429.89
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	29	26	$542.84	$136.68
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	28	23	$613.42	$308.79
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	28	26	$294.66	$132.48
17004 Destruction of precancer skin growth, 15 or more growths	26	19	$328.07	$158.85
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	20	15	$777.72	$388.86
11104 Punch biopsy, first skin growth	20	16	$256.97	$122.88
69100 Biopsy of ear	19	17	$197.05	$81.03
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	16	12	$564.18	$142.09
10060 Simple or single drainage of skin abscess	16	15	$246.90	$124.28

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	773	163	$15.30	$5.76
99213 Established patient office or other outpatient visit, typically 15 minutes	709	446	$150.08	$73.89
11102 Tangential biopsy of single skin lesion	355	270	$199.47	$92.96
17000 Destruction of skin growth	347	247	$132.81	$46.98
11103 Biopsy of related skin growth, each additional growth	207	120	$104.61	$51.60
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	121	88	$218.23	$106.61
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	98	86	$91.24	$45.16
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	76	76	$216.06	$106.22
17110 Destruction of up to 14 skin growths	67	63	$221.53	$110.20
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	39	34	$496.13	$124.56
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	38	31	$545.87	$133.44
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	37	27	$290.33	$113.59
12032 Intermediate repair of wound of scalp, underarms, trunk, arms, or legs, 2.6-7.5 cm	36	34	$605.07	$298.29
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	36	34	$963.43	$464.96
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	29	25	$353.47	$169.80
69100 Biopsy of ear	28	26	$196.81	$57.13
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	27	24	$865.46	$413.09
17004 Destruction of precancer skin growth, 15 or more growths	22	18	$314.71	$152.93
11622 Removal of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	21	20	$513.10	$137.42
11104 Punch biopsy, first skin growth	17	17	$249.96	$119.04
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	13	13	$567.83	$139.07

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J7345 Aminolevulinic acid hcl for topical administration, 10% gel, 10 mg	4,200	15	$2.83	$1.40
17003 Destruction of precancer skin growth, 2-14 growths	1,128	203	$19.18	$5.52
99213 Established patient office or other outpatient visit, typically 15 minutes	797	525	$149.27	$73.43
17000 Destruction of skin growth	481	306	$135.67	$49.91
11102 Tangential biopsy of single skin lesion	451	339	$201.06	$91.14
11103 Biopsy of related skin growth, each additional growth	288	155	$97.42	$51.56
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	180	131	$90.00	$44.53
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	122	94	$218.28	$107.40
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	98	98	$218.65	$107.26
17110 Destruction of up to 14 skin growths	66	58	$220.00	$107.20
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	59	44	$502.27	$124.29
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	49	42	$872.41	$431.80
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	49	40	$291.24	$122.06
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	45	33	$356.27	$158.65
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	42	34	$809.12	$386.24
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	39	34	$957.00	$477.20
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	32	26	$551.00	$140.80
96574 Application of light with debridement to destroy precancer skin growth	31	18	$502.06	$248.80
11104 Punch biopsy, first skin growth	28	27	$248.57	$120.50
17004 Destruction of precancer skin growth, 15 or more growths	28	26	$307.00	$151.46
11622 Removal of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	20	20	$520.00	$135.19
69100 Biopsy of ear	19	18	$197.16	$92.66
11105 Punch biopsy, each additional skin growth	15	11	$122.80	$60.38
99202 New patient office or other outpatient visit, typically 20 minutes	15	15	$153.67	$75.80
13131 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 1.1-2.5 cm	12	12	$790.00	$391.23

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
J7345 Aminolevulinic acid hcl for topical administration, 10% gel, 10 mg	2,800	13	$2.85	$1.42
17003 Destruction of precancer skin growth, 2-14 growths	1,454	252	$16.90	$5.19
99213 Established patient office or other outpatient visit, typically 15 minutes	974	634	$146.42	$71.92
11100 Biopsy of single growth of skin and/or tissue	567	446	$209.25	$98.69
17000 Destruction of skin growth	514	347	$137.44	$49.88
11101 Biopsy of each additional growth of skin and/or tissue	296	169	$66.60	$32.93
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	193	153	$214.83	$105.76
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	185	142	$86.79	$43.06
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	155	155	$217.59	$107.79
17110 Destruction of up to 14 skin growths	91	79	$217.75	$108.62
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	54	45	$862.00	$421.64
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	53	45	$966.23	$475.79
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	53	40	$501.85	$123.69
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	46	39	$289.22	$124.64
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	45	37	$353.20	$163.16
17004 Destruction of precancer skin growth, 15 or more growths	45	40	$301.04	$140.02
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	36	32	$550.56	$135.61
99202 New patient office or other outpatient visit, typically 20 minutes	34	34	$148.59	$74.55
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	33	31	$797.79	$381.75
11622 Removal of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	28	26	$520.00	$137.22
69100 Biopsy of ear	22	22	$202.55	$72.58
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	17	14	$575.29	$150.69
96574 Application of light with debridement to destroy precancer skin growth	15	12	$480.00	$235.81

HCPCS Code & Description	Services	Patients	Submitted Charge	Medicare Allowed
17003 Destruction of precancer skin growth, 2-14 growths	1,179	218	$22.49	$5.53
99213 Established patient office or other outpatient visit, typically 15 minutes	870	532	$146.00	$71.78
11100 Biopsy of single growth of skin and/or tissue	527	394	$209.44	$96.32
17000 Destruction of skin growth	468	314	$160.19	$50.13
99214 Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more	278	204	$214.00	$105.50
11101 Biopsy of each additional growth of skin and/or tissue	277	159	$66.00	$32.02
99203 New patient office or other outpatient visit with low level of medical decision making, if using time, 30 minutes or more	179	179	$217.68	$107.18
99212 Established patient office or other outpatient visit with straightforward medical decision making, if using time, 10 minutes or more	119	95	$86.69	$42.84
17110 Destruction of up to 14 skin growths	86	76	$218.60	$107.13
11602 Removal of cancer skin growth of body, arms, or legs, 1.1-2.0 cm	61	53	$505.57	$123.06
13121 Repair of wound (2.6 to 7.5 centimeters) of scalp, arms, and/or legs	60	51	$874.17	$418.03
13132 Complicated repair of wound of forehead, cheeks, chin, mouth, neck, underarms, genitals, hands, or feet, 2.6-7.5 cm	40	36	$978.40	$474.13
17261 Destruction of cancer skin growth of trunk, arms, or legs, 0.6-1.0 cm	35	28	$293.60	$127.31
13101 Complicated repair of wound of trunk, 2.6-7.5 cm	35	33	$812.00	$392.29
17262 Destruction of cancer skin growth of trunk, arms, or legs, 1.1-2.0 cm	34	24	$357.85	$147.82
69100 Biopsy of ear	34	28	$205.56	$65.74
17004 Destruction of precancer skin growth, 15 or more growths	33	30	$331.27	$144.07
11642 Removal of cancer skin growth of face, ears, eyelids, nose, lips, or mouth, 1.1-2.0 cm	24	24	$558.00	$140.74
J7308 Aminolevulinic acid hcl for topical administration, 20%, single unit dosage form (354 mg)	23	16	$655.87	$356.68
96567 Application of light and light-sensitive drugs to aid destruction of premalignant skin growths, per session	23	17	$289.04	$129.34
11622 Removal of cancer skin growth of scalp, neck, hands, feet, or genitals, 1.1-2.0 cm	22	18	$524.73	$127.42
99202 New patient office or other outpatient visit, typically 20 minutes	20	20	$148.10	$73.83
11603 Removal of cancer skin growth of body, arms, or legs, 2.1-3.0 cm	17	16	$579.00	$142.68

Medical Specialties & State Licenses

Dermatology Primary Specialty

NUCC Taxonomy Code: 207N00000X

State License FL OS6144

A dermatologist is trained to diagnose and treat pediatric and adult patients with benign and malignant disorders of the skin, mouth, external genitalia, hair and nails, as well as a number of sexually transmitted diseases. The dermatologist has had additional training and experience in the diagnosis and treatment of skin cancers, melanomas, moles and other tumors of the skin, the management of contact dermatitis and other allergic and nonallergic skin disorders, and in the recognition of the skin manifestations of systemic (including internal malignancy) and infectious diseases. Dermatologists have special training in dermatopathology and in the surgical techniques used in dermatology. They also have expertise in the management of cosmetic disorders of the skin such as hair loss and scars and the skin changes associated with aging.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

5 Associated Practitioners

Sandra Snyder , PA

Physician Assistant - Medical

NPI 1053300723

Physician Assistant

Dr. Michael Scannon , MD

Dermatology - Procedural Dermatology

NPI 1396734851

Doctor of Medicine (M.D.)

Jeffrey Moulton , PA-C

Physician Assistant - Medical

NPI 1518009612

Physician Assistant (Certified)

Jessica Hage , PA

Physician Assistant - Medical

NPI 1649553587

Physician Assistant

Carole Mazzone , ARNP

Nurse Practitioner - Adult Health

NPI 1770551202

Advanced Registered Nurse Practitioner

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

10 Historical Events

⚠️

NPI Profile Deactivated October 16, 2024

Record deactivated on October 16, 2024

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) August 31, 2024

Dermatology (License #OS6144 in FL)

📍

Updated Practice Location July 10, 2019

Registered at 9170 OAKHURST RD STE 1, SEMINOLE, FL 337762112 (Tel: 7275173376)

✅

NPI Profile Active February 24, 2014

NPI status registered as active in NPPES database

📍

Updated Practice Location February 24, 2014

Registered at 4200 N ARMENIA AVE, SUITE 1, TAMPA, FL 336076438 (Tel: 8138774811)

📍

Updated Business Mailing Address February 24, 2014

Registered at 4200 N ARMENIA AVE, SUITE 1, TAMPA, FL 336076438 (Tel: 8138774811)

👤

Provider Name / Credentials Updated February 24, 2014

Recorded as GEORGE BONDAR, D.O.

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) February 24, 2014

Dermatology (License #OS6144 in FL)

🎓

Medical Taxonomy / Specialty Registered (Primary Specialty) February 24, 2014

Dermatology (License #OP00001470 in WA)

🟢

Initial NPI Registration & Enumeration August 09, 2005

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1902807365

Entity Type:

Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)

Enumeration Date: August 09, 2005

Last Update: February 24, 2014

Deactivation Date: October 16, 2024

Update or Correct Profile

Mailing Address

4200 N Armenia Ave, Suite 1

Tampa, FL 336076438

Phone: 8138774811

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).

⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.