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General NPI Number Information
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NPI Number | 1053877506
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Entity Type | Organization
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Legal Business Name | PREMIER MED PA
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Dates
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Enumeration Date | 02/20/2019
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Last Update Date | 10/18/2019
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Provider Practice Location Address
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Address Line | 2906 17TH ST.
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City | ST CLOUD
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State | FL
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Zip | 34769
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Country | US
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Telephone | 407-543-6306
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Fax |
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Provider Business Mailing Address
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Address Line | 7512 DR PHILLIPS BLVD STE 50-344
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City | ORLANDO
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State | FL
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Zip | 32819-5420
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Country | US
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Telephone | 407-543-6306
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JAUVID BEHRAM AYADI
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Credential |
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Telephone | 407-352-2542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number |
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License Number State |
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