Healthcare Provider Details

I. General information

NPI: 1568457422
Provider Name (Legal Business Name): DELORES R GARCIA-CHUNG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2005
Last Update Date: 05/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

950 COUNTY ROAD 17A W
AVON PARK FL
33825-2164
US

IV. Provider business mailing address

950 COUNTY ROAD 17A W
AVON PARK FL
33825-2164
US

V. Phone/Fax

Practice location:
  • Phone: 863-452-3000
  • Fax: 863-452-3029
Mailing address:
  • Phone: 863-452-3000
  • Fax: 863-452-3069

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME82414
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: