Healthcare Provider Details

I. General information

NPI: 1528368263
Provider Name (Legal Business Name): ERIC VERFAILLIE PA-C, MMS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2010
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

927 45TH ST STE 201
MANGONIA PARK FL
33407-2450
US

IV. Provider business mailing address

5955 PONCE DE LEON BLVD
CORAL GABLES FL
33146-2423
US

V. Phone/Fax

Practice location:
  • Phone: 561-844-6363
  • Fax: 833-464-4215
Mailing address:
  • Phone: 305-661-1515
  • Fax: 305-662-3723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9105726
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: