Healthcare Provider Details

I. General information

NPI: 1437755345
Provider Name (Legal Business Name): WEST FLORIDA MEDICAL ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/07/2020
Last Update Date: 12/07/2020
Certification Date: 12/07/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 N INGLIS AVE STE B
INGLIS FL
34449-9463
US

IV. Provider business mailing address

3920 N GRAYHAWK LOOP
LECANTO FL
34461-8471
US

V. Phone/Fax

Practice location:
  • Phone: 352-447-2122
  • Fax: 352-465-7576
Mailing address:
  • Phone: 352-464-0762
  • 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: ULHAS T DEVEN
Title or Position: PRESIDENT
Credential: MD
Phone: 352-464-0762