Healthcare Provider Details

I. General information

NPI: 1164526273
Provider Name (Legal Business Name): NORTH COUNTY MEDICAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13838 US HIGHWAY 1
SEBASTIAN FL
32958-3296
US

IV. Provider business mailing address

PO BOX 220
ROSELAND FL
32957-0220
US

V. Phone/Fax

Practice location:
  • Phone: 772-581-6900
  • Fax: 772-581-3395
Mailing address:
  • Phone: 772-581-6900
  • Fax: 772-581-3395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. DAVID DEPUTRON
Title or Position: PARTNER
Credential: D.O.
Phone: 772-581-6900