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General NPI Number Information
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NPI Number | 1033766027
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Entity Type | Organization
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Legal Business Name | MD PRIMARY CARE INC
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Dates
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Enumeration Date | 08/23/2019
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Last Update Date | 08/23/2019
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Provider Practice Location Address
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Address Line | 2215 NEBRASKA AVE STE 2-B
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City | FORT PIERCE
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State | FL
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Zip | 34950-4866
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Country | US
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Telephone | 772-302-3767
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Fax | 888-436-7197
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Provider Business Mailing Address
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Address Line | 8113 KIAWAH TRCE
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-3026
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Country | US
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Telephone | 619-398-6333
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Fax | 888-436-7197
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Authorized Official
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Title or Position | CEO
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Name | DR. CHINTAN B SHAH
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Credential | MD
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Telephone | 619-398-6333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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