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General NPI Number Information
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NPI Number | 1144417791
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Entity Type | Organization
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Legal Business Name | FDM,PLC
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Dates
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Enumeration Date | 09/27/2007
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Last Update Date | 11/03/2011
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Provider Practice Location Address
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Address Line | 14100 FIVAY RD STE 120
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City | HUDSON
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State | FL
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Zip | 34667-7159
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Country | US
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Telephone | 727-819-2338
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Fax | 727-819-2481
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Provider Business Mailing Address
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Address Line | PO BOX 2089
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City | TARPON SPRINGS
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State | FL
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Zip | 34688-2089
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Country | US
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Telephone | 727-819-2338
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Fax | 727-819-2481
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Authorized Official
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Title or Position | CEO
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Name | DR. RAJIVA GOYAL
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Credential | MD
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Telephone | 727-819-2338
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME80055
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License Number State | FL
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