Healthcare Provider Details

I. General information

NPI: 1720278393
Provider Name (Legal Business Name): PHYSICIAN CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 12/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E MADISON ST
STARKE FL
32091-4043
US

IV. Provider business mailing address

132 E MADISON ST
STARKE FL
32091-4043
US

V. Phone/Fax

Practice location:
  • Phone: 904-964-6500
  • Fax: 904-964-9170
Mailing address:
  • Phone: 904-964-6500
  • Fax: 904-964-9170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME0049847
License Number StateFL

VIII. Authorized Official

Name: DR. GEORGE L RESTEA
Title or Position: PRESIDENT
Credential: MD
Phone: 904-964-6500