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General NPI Number Information
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NPI Number | 1083045918
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Entity Type | Organization
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Legal Business Name | VQOL PRIMARY CARE PHYSICIAN
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Dates
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Enumeration Date | 12/03/2013
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Last Update Date | 04/02/2019
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Provider Practice Location Address
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Address Line | 8550 NE 138TH LN STE 102
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City | LADY LAKE
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State | FL
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Zip | 32159-6816
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Country | US
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Telephone | 352-314-2922
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 490625
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City | LEESBURG
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State | FL
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Zip | 34749-0625
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Country | US
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Telephone | 352-314-2922
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | CLAUDE DANOIS
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Credential | MD
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Telephone | 352-314-2922
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME106117
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License Number State | FL
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