Healthcare Provider Details

I. General information

NPI: 1528493137
Provider Name (Legal Business Name): PREMIER PEDIATRICS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2013
Last Update Date: 06/17/2021
Certification Date: 06/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7960 SW 60TH AVE SUITE 200
OCALA FL
34476-6457
US

IV. Provider business mailing address

7960 SW 60TH AVE SUITE 100
OCALA FL
34476-6457
US

V. Phone/Fax

Practice location:
  • Phone: 352-671-6741
  • Fax: 352-671-6742
Mailing address:
  • Phone: 352-671-6741
  • Fax: 352-671-6742

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberME96086
License Number StateFL

VIII. Authorized Official

Name: SHAHAB EUNUS
Title or Position: PRESIDENT
Credential:
Phone: 352-671-6741