Healthcare Provider Details

I. General information

NPI: 1518731264
Provider Name (Legal Business Name): FLORIDA CLINICAL PRACTICE ASSOCIATION INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

457 SE 20TH ST
GAINESVILLE FL
32641-7466
US

IV. Provider business mailing address

PO BOX 13833
PHILADELPHIA PA
19101-3833
US

V. Phone/Fax

Practice location:
  • Phone: 352-265-7015
  • Fax: 352-265-7021
Mailing address:
  • Phone: 352-265-7922
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARVIN A. DEWAR
Title or Position: SR. ASSOCIATE DEAN/CEO
Credential: MD, JD
Phone: 352-265-0301