| My Doctor Medical Group Corp | |
|
6822 W Waters Ave Tampa FL 33634-2212 | |
| (813) 280-4909 | |
| (813) 302-7143 |
| Full Name | My Doctor Medical Group Corp |
|---|---|
| Speciality | General Practice |
| Location | 6822 W Waters Ave, Tampa, Florida |
| Authorized Official Name and Position | Alejandro Gonzalez (PRESIDENT) |
| Authorized Official Contact | 8132804909 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| My Doctor Medical Group Corp 6822 W Waters Ave Tampa FL 33634-2212 Ph: (813) 280-4909 | My Doctor Medical Group Corp 6822 W Waters Ave Tampa FL 33634-2212 Ph: (813) 280-4909 |
| NPI Number | 1295237675 |
|---|---|
| Provider Enumeration Date | 03/01/2018 |
| Last Update Date | 10/31/2024 |
| Medicare PECOS PAC ID | 6305100371 |
|---|---|
| Medicare Enrollment ID | O20180430001241 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295237675 | NPI | - | NPPES |
| 101345800 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Mayrene Alfonso Perez |
|---|---|
| Provider Type | Practitioner - General Practice |
| Provider Identifiers | NPI Number: 1124642012 PECOS PAC ID: 9931510591 Enrollment ID: I20201203000164 |
| Provider Name | Belkis Perez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1649940768 PECOS PAC ID: 1557751021 Enrollment ID: I20211124001913 |
| Provider Name | Mario Angel Cruz Cabrera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1124735527 PECOS PAC ID: 4082088158 Enrollment ID: I20230314000587 |
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