Mario E Profet, MD, RDMS, RDCS, RPVI
General Practice in Tampa, FL. Individual provider (NPI-1).
NPI number1487795092
StatusActive
Last updated in NPPESOct 24, 2019
Details
- NPI
- 1487795092
- Entity type
- Individual (NPI-1)
- Name
- Mario E Profet
- Credential
- MD, RDMS, RDCS, RPVI
- Sex
- Male
- Sole proprietor
- Yes
- Enumeration date
- Feb 8, 2007
- Last updated
- Oct 24, 2019
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 208D00000X | General Practice | ME135981 | FL | Yes |
| 208D00000X | General Practice | ACN304 | FL | |
| 246XS1301X | Spec/Tech, Cardiovascular, Sonography | 76083 | – | |
| 2471S1302X | Radiologic Technologist, Sonography | 76083 | – | |
| 2471V0105X | Radiologic Technologist, Vascular Sonography | 76083 | – |
Practice location
11017 N Dale Mabry Hwy Ste BTampa, FL 33618-3873
Phone 813-337-7402 · Fax 813-461-6462
Mailing address
11017 N Dale Mabry Hwy Ste BTampa, FL 33618-3873
Phone 133-377-4028 · Fax 813-461-6462
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