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General NPI Number Information
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NPI Number | 1174251227
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Entity Type | Organization
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Legal Business Name | EIR WELLNESS, LLC
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Dates
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Enumeration Date | 08/08/2022
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Last Update Date | 11/28/2022
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Provider Practice Location Address
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Address Line | 802 TUSCANNY ST
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City | BRANDON
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State | FL
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Zip | 33511-6151
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Country | US
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Telephone | 863-825-6121
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Fax |
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Provider Business Mailing Address
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Address Line | 802 TUSCANNY ST
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City | BRANDON
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State | FL
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Zip | 33511-6151
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MD
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Name | DR. MARY JOYCE GAN
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Credential | MD
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Telephone | 863-825-6121
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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 | 2080P0205X
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Taxonomy Name | Pediatric Endocrinology Physician
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License Number |
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License Number State |
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