TRACY S FANSLER MD LLC
Medical Practice at Seminole Blvd, Largo, FL

License number
Florida ME68721
Category
Medical Practice
Type
Specialist
Owner
Name: TRACY S FANSLER M.D.
Title: PRESIDENT
Phone: (727) 584-9500
Address
Address
12955 Seminole Blvd, Largo, FL 33778
National Provider ID: 1902091721
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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TRACY S. FANSLER, M.D., LLC

Largo, FL

Status:
Inactive
Industry:
Medical Doctor's Office
Doing business as:
Tracy S. Fansler, M.D
Inactive reason:
REINSTATEMENT
Registration:
Jun 14, 2004
Inactive since:
May 13, 2014
Phone:
(727) 584-9500 (Phone)
Addresses:
12955 Seminole Blvd, Largo, FL 33778 (Physical)
13200 72 Ave, Largo, FL 33776
State ID:
L04000044819
Business type:
Florida Limited Liability Company
Manager, Presidents:
Fansler, Tracy S, M.d, 12955 Seminole Blvd, Seminole, FL 33776 (Physical),Tracy S Fansler Md,Tracy S. Fansler (Manager, President)
Agent:
Jim Caniano,2700 E Bay Dr, Largo, FL 33771 (Physical)
EIN:
20-1240476

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