Healthcare Provider Details

I. General information

NPI: 1740673300
Provider Name (Legal Business Name): AFERMIN PRIMARY CARE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2015
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2089 S RIDGEWOOD AVE
SOUTH DAYTONA FL
32119-2240
US

IV. Provider business mailing address

500 MEMORIAL CIR STE A
ORMOND BEACH FL
32174-5054
US

V. Phone/Fax

Practice location:
  • Phone: 386-767-7533
  • Fax:
Mailing address:
  • Phone: 386-334-1295
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME0020477
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME0086562
License Number StateFL

VIII. Authorized Official

Name: DR. PATRICK JOHN LARRAZABAL
Title or Position: OWNER/PROVIDER
Credential: M.D.
Phone: 386-334-1295