Provider Demographics
NPI:1174721575
Name:PASCO ORTHOPEDICS AND SPORTS MEDICINE PA
Entity type:Organization
Organization Name:PASCO ORTHOPEDICS AND SPORTS MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCGRAW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:813-782-0100
Mailing Address - Street 1:38332 DAUGHTERY RD
Mailing Address - Street 2:
Mailing Address - City:ZEPHYRHILLS
Mailing Address - State:FL
Mailing Address - Zip Code:33540-1486
Mailing Address - Country:US
Mailing Address - Phone:813-782-0100
Mailing Address - Fax:813-782-0115
Practice Address - Street 1:38332 DAUGHTERY RD
Practice Address - Street 2:
Practice Address - City:ZEPHYRHILLS
Practice Address - State:FL
Practice Address - Zip Code:33540-1486
Practice Address - Country:US
Practice Address - Phone:813-782-0100
Practice Address - Fax:813-782-0115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-06
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0S8393207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLH30662Medicare UPIN
FL02931AMedicare ID - Type Unspecified