Healthcare Provider Details

I. General information

NPI: 1548447535
Provider Name (Legal Business Name): ST LUCIE MEDICAL SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/22/2008
Last Update Date: 03/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 SE HILLMOOR DR
PORT ST LUCIE FL
34952-7539
US

IV. Provider business mailing address

3 MARYLAND FARMS SUITE 250
BRENTWOOD TN
37027-5005
US

V. Phone/Fax

Practice location:
  • Phone: 772-335-9600
  • Fax: 772-335-9699
Mailing address:
  • Phone: 800-661-3365
  • Fax: 866-689-4661

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GARY DUNCAN
Title or Position: VP
Credential:
Phone: 954-767-5716