Healthcare Provider Details

I. General information

NPI: 1043486806
Provider Name (Legal Business Name): MEDICAL ASSOCIATES OF WEST FLORIDA NETWORK, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2008
Last Update Date: 10/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7575 STATE ROAD 52
HUDSON FL
34667-6716
US

IV. Provider business mailing address

7575 STATE ROAD 52
HUDSON FL
34667-6716
US

V. Phone/Fax

Practice location:
  • Phone: 727-861-9800
  • Fax:
Mailing address:
  • Phone: 727-861-9800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT L DUNCAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 727-861-9800