Healthcare Provider Details

I. General information

NPI: 1831525930
Provider Name (Legal Business Name): PREMIER PEDIATRICS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2013
Last Update Date: 09/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 SE 17TH ST SUITE 604
OCALA FL
34471-5178
US

IV. Provider business mailing address

7960 SW 60TH AVE
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