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General NPI Number Information
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NPI Number | 1104268341
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Entity Type | Organization
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Legal Business Name | FAMILY MEDICAL EXPRESS AND RIVERVIEW PEDIATRICS
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Dates
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Enumeration Date | 07/29/2013
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Last Update Date | 07/29/2013
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Provider Practice Location Address
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Address Line | 107 W ROBERTSON ST
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City | BRANDON
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State | FL
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Zip | 33511-5111
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Country | US
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Telephone | 813-438-8947
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Fax | 813-438-8940
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Provider Business Mailing Address
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Address Line | 107 W ROBERTSON ST
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City | BRANDON
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State | FL
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Zip | 33511-5111
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Country | US
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Telephone | 813-438-8947
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Fax | 813-438-8940
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Authorized Official
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Title or Position | PRES
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Name | MRS. YVONNE CLARKE
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Credential | ARNP
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Telephone | 813-438-8947
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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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 | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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Taxonomy #3
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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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