Healthcare Provider Details

I. General information

NPI: 1760666549
Provider Name (Legal Business Name): INTERNATIONAL ASSOCIATION OF FIRE FIGHTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2007
Last Update Date: 01/13/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 N HALIFAX AVE
DAYTONA BEACH FL
32118-3732
US

IV. Provider business mailing address

PO BOX 1162
DAYTONA BEACH FL
32115-1162
US

V. Phone/Fax

Practice location:
  • Phone: 386-248-1162
  • Fax:
Mailing address:
  • Phone: 386-248-1162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208U00000X
TaxonomyClinical Pharmacology Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL TYRRELL
Title or Position: PRESIDENT/CEO
Credential:
Phone: 386-615-9975