Healthcare Provider Details

I. General information

NPI: 1730185307
Provider Name (Legal Business Name): ENDOCRINOLOGY OF CENTRAL FLORIDA PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 04/24/2024
Certification Date: 04/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 VICTORIA COMMONS BLVD
DELAND FL
32724-7700
US

IV. Provider business mailing address

141 VICTORIA COMMONS BLVD
DELAND FL
32724-7700
US

V. Phone/Fax

Practice location:
  • Phone: 386-427-4544
  • Fax: 386-427-8688
Mailing address:
  • Phone: 386-427-4544
  • Fax: 386-427-8688

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: LEE NATHANIEL METCHICK
Title or Position: PRESIDENT
Credential: MD
Phone: 386-427-4544