10D1053889 CLIA NUMBER - PHYSICIANS GROUP LLC - DE

Laboratory Demographics

  • CLIA Code: 10D1053889
  • Facility Name: PHYSICIANS GROUP LLC - DE
  • Facility Address: 12233 N FLORIDA AVE STE 200
    TAMPA, FL
    ZIP 33612
  • Facility Phone: 813 961-5800
  • Facility Type: Physician Office
  • Facility Type: Waiver
  • Lab Director: DR. GREGORY A. BRONNER
  • NPI Number: 1295927663
  • Taxonomy: 291U00000X - Clinical Medical Laboratory

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CLIA Record

Field Name Field Value
CLIA Number 10D1053889
LAB Type Physician Office
Facility Name PHYSICIANS GROUP LLC - DE
Street 12233 N FLORIDA AVE STE 200
City TAMPA
State FL
ZIP 33612
Phone 813 961-5800
Certificate Type Certificate of Waiver
Certificate Type Description This certificate is issued to a laboratory to perform only waived tests.
Certificate Effective Date 5/8/2024
Certificate Expiration Date 5/7/2026
Facility Type Physician Office
Lab Director DR. GREGORY A. BRONNER

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This page was last updated on: 9/29/2025