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General NPI Number Information
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NPI Number | 1184724262
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Entity Type | Organization
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Legal Business Name | HUNT CLUB MEDICAL PLC
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 01/19/2012
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Provider Practice Location Address
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Address Line | 3191 E SEMORAN BLVD
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City | APOPKA
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State | FL
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Zip | 32703-5943
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Country | US
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Telephone | 407-788-6500
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Fax | 407-869-9400
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Provider Business Mailing Address
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Address Line | 3191 E SEMORAN BLVD
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City | APOPKA
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State | FL
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Zip | 32703-5943
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Country | US
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Telephone | 407-788-6500
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Fax | 407-869-9400
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Authorized Official
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Title or Position | PRESIDENT
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Name | MICHAEL GORDON
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Credential | MD
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Telephone | 407-788-6500
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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 |
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License Number State |
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