Healthcare Provider Details

I. General information

NPI: 1386751907
Provider Name (Legal Business Name): FLORIDA DEPARTMENT OF HEALTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 05/20/2021
Certification Date: 05/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2555 JUDGE FRAN JAMIESON WAY
VIERA FL
32940-5998
US

IV. Provider business mailing address

2565 JUDGE FRAN JAMIESON WAY
VIERA FL
32940-5998
US

V. Phone/Fax

Practice location:
  • Phone: 321-639-5800
  • Fax: 321-449-5015
Mailing address:
  • Phone: 321-454-7148
  • Fax: 321-449-5015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1102X
TaxonomyMilitary Outpatient Operational (Transportable) Component Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. MURRAY F DWECK
Title or Position: DIRECTOR
Credential: MD
Phone: 321-454-7148