MEDICARE: DR BEHAL'S FAMILY PRACTICE CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	ME91856	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	01501	OTHER	FL	BCBS OF FL

General Provider Information

NPI Number	:	1801054036
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR BEHAL'S FAMILY PRACTICE CLINIC

Provider Business Mailing Address
First Line	:	1138 CARLTON AVE
Second Line	:
City	:	LAKE WALES
State	:	FL
Zip	:	33853-4305
Country	:	US
Telephone Number	:	863-678-9900
Fax Number	:	863-678-9278

Provider Business Practice Location Address
First Line	:	1138 CARLTON AVE
Second Line	:
City	:	LAKE WALES
State	:	FL
Zip	:	33853-4305
Country	:	US
Telephone Number	:	863-678-9900
Fax Number	:	863-678-9278

Authorized Official
Title or Position	:	MANAGER
Name	:	TERENCE D' VAZ
Credential	:
Telephone Number	:	863-232-5062

Provider Enumeration Date	:	05/23/2008
Last Update Date	:	05/23/2008

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