10D1096369 CLIA NUMBER - GEORGE S SIDHOM MD PA D/B/A BRANDON PAIN CLINIC

Laboratory Demographics

CLIA Number: 10D1096369

Facility Name: GEORGE S SIDHOM MD PA D/B/A BRANDON PAIN CLINIC

Facility Address:
722 BOWING OAK DR
BRANDON, FL
ZIP 33511
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Facility Phone Number: 813 684-7246

Facility Type: Physician Office

Certificate Type: Certificate of Compliance

NPI Number: 1336336130

Taxonomy: 174400000X - Specialist
An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree.

CLIA Record

Field Name	Field Value
CLIA Number	10D1096369
LAB Type	Physician Office
Facility Name	GEORGE S SIDHOM MD PA D/B/A BRANDON PAIN CLINIC
Street	722 BOWING OAK DR
City	BRANDON
State	FL
ZIP	33511
Phone	813 684-7246
CertificateType	2
CertificateEffectiveDate	5/12/2024
CertificateExpirationDate	5/11/2026
FacilityType	Compliance

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