Healthcare Provider Details

I. General information

NPI: 1205408002
Provider Name (Legal Business Name): WEST FLORIDA MEDICAL ASSOCIATES P A
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2021
Last Update Date: 07/13/2021
Certification Date: 07/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7648 S FLORIDA AVE
FLORAL CITY FL
34436-2738
US

IV. Provider business mailing address

PO BOX 640573
BEVERLY HILLS FL
34464-0573
US

V. Phone/Fax

Practice location:
  • Phone: 352-726-3700
  • Fax: 352-726-8570
Mailing address:
  • Phone: 352-489-2486
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BHADRESH K PATEL
Title or Position: PRESIDENT
Credential: MD
Phone: 352-436-5907