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General NPI Number Information
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NPI Number | 1205097060
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Entity Type | Organization
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Legal Business Name | TECSON FAMILY PRACTICE INC
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Dates
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Enumeration Date | 06/24/2008
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Last Update Date | 09/29/2008
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Provider Practice Location Address
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Address Line | 725 S 6TH ST MACCLE
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City | MACCLENNY
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State | FL
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Zip | 32063
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Country | US
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Telephone | 904-259-3150
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Fax | 904-259-7890
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Provider Business Mailing Address
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Address Line | 725 S 6TH ST
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City | MACCLENNY
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State | FL
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Zip | 32063
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Country | US
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Telephone | 904-259-3150
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Fax | 904-259-7890
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Authorized Official
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Title or Position | OWNER
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Name | MR. ANGELITO B TECSON
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Credential | MD
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Telephone | 904-259-3150
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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 | 00ME28296
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License Number State | FL
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