Healthcare Provider Details

I. General information

NPI: 1992067342
Provider Name (Legal Business Name): WEST FLORIDA PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2012
Last Update Date: 06/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3733 E GULF TO LAKE HWY SUITE B
INVERNESS FL
34453-3206
US

IV. Provider business mailing address

3733 E GULF TO LAKE HWY SUITE B
INVERNESS FL
34453-3206
US

V. Phone/Fax

Practice location:
  • Phone: 352-746-3338
  • Fax: 352-344-3414
Mailing address:
  • Phone: 352-746-3338
  • Fax: 352-344-3414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME90418
License Number StateFL

VIII. Authorized Official

Name: DR. UDAY HIREMATH
Title or Position: OWNER
Credential:
Phone: 352-746-3338