10D1056366 CLIA NUMBER - JAWAN AYER- COLE MD LLC

Laboratory Demographics

CLIA Number: 10D1056366

Facility Name: JAWAN AYER- COLE MD LLC

Facility Address:
800 W DR MARTIN LUTHER KING JR BLVD STE 4
TAMPA, FL
ZIP 33603
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Facility Phone Number: 813 910-8700

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1962622134

Taxonomy: 261QM1300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D1056366
LAB Type	Physician Office
Facility Name	JAWAN AYER- COLE MD LLC
Street	800 W DR MARTIN LUTHER KING JR BLVD STE 4
City	TAMPA
State	FL
ZIP	33603
Phone	813 910-8700
CertificateType	4
CertificateEffectiveDate	7/14/2022
CertificateExpirationDate	7/13/2024
FacilityType	Waiver

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This page was last updated on: 4/23/2024