Healthcare Provider Details

I. General information

NPI: 1184804585
Provider Name (Legal Business Name): LIMERES MEDICAL CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/14/2007
Last Update Date: 03/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 ZEAGLER DR STE 102
PALATKA FL
32177-6856
US

IV. Provider business mailing address

530 ZEAGLER DR STE 102
PALATKA FL
32177-6856
US

V. Phone/Fax

Practice location:
  • Phone: 386-326-0223
  • Fax: 386-326-0664
Mailing address:
  • Phone: 386-326-0223
  • Fax: 386-326-0664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME76533
License Number StateFL

VIII. Authorized Official

Name: DR. MIGUEL MANUEL LIMERES JR.
Title or Position: OWNER
Credential: M.D.
Phone: 386-326-0223