Healthcare Provider Details

I. General information

NPI: 1356532204
Provider Name (Legal Business Name): KIDS FIRST PEDIATRICS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 08/06/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OSPREY BLVD S 107
BARTOW FL
33830
US

IV. Provider business mailing address

2000 OSPREY BLVD 107
BARTOW FL
33830
US

V. Phone/Fax

Practice location:
  • Phone: 863-533-1123
  • Fax: 863-519-9808
Mailing address:
  • Phone: 863-533-1123
  • Fax: 863-519-9808

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME83372
License Number StateFL

VIII. Authorized Official

Name: DEBORAH K FORD
Title or Position: PRESIDENT
Credential: MD
Phone: 863-533-1123