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General NPI Number Information
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NPI Number | 1184132888
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Entity Type | Organization
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Legal Business Name | FAMILY PRACTICE ON THE GO OF FLORIDA
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Dates
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Enumeration Date | 01/16/2018
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Last Update Date | 10/15/2024
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Provider Practice Location Address
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Address Line | 226 N NOVA RD STE 184
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City | ORMOND BEACH
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State | FL
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Zip | 32174-5124
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Country | US
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Telephone | 888-808-0488
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Fax | 386-872-4232
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Provider Business Mailing Address
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Address Line | 735 DUNLAWTON AVE
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City | PORT ORANGE
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State | FL
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Zip | 32127-9226
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Country | US
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Telephone | 888-808-0488
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Fax | 386-872-4232
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID HEISE
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Credential | MD
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Telephone | 888-808-0488
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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 | ME83299
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License Number State | FL
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