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General NPI Number Information
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NPI Number | 1144418666
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Entity Type | Organization
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Legal Business Name | JARQUIN FAMILY PRACTICE LLC
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Dates
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Enumeration Date | 10/10/2007
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Last Update Date | 10/10/2007
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Provider Practice Location Address
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Address Line | 205 N SCENIC HWY
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City | FROSTPROOF
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State | FL
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Zip | 33843
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Country | US
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Telephone | 863-635-4100
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Fax | 863-635-4499
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Provider Business Mailing Address
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Address Line | 205 N SCENIC HWY
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City | FROSTPROOF
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State | FL
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Zip | 33843
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Country | US
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Telephone | 863-635-4100
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Fax | 863-635-4499
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Authorized Official
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Title or Position | DR
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Name | ALVARO JOSE JARQUIN
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Credential | MD
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Telephone | 863-635-4100
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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 | ME78476
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License Number State | FL
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