Healthcare Provider Details

I. General information

NPI: 1164760716
Provider Name (Legal Business Name): VMD PRIMARY CARE ,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2013
Last Update Date: 01/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3225 AVIATION AVE SUITE 700
MIAMI FL
33133-4741
US

IV. Provider business mailing address

3225 AVIATION AVE SUITE 700
MIAMI FL
33133-4741
US

V. Phone/Fax

Practice location:
  • Phone: 305-273-4641
  • Fax: 305-273-1497
Mailing address:
  • Phone: 305-273-4641
  • Fax: 305-273-1497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. FRANCISCO LEON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 305-273-4641