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General NPI Number Information
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NPI Number | 1215334370
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Entity Type | Organization
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Legal Business Name | SHORES MEDICAL CENTER
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Dates
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Enumeration Date | 12/04/2014
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Last Update Date | 12/04/2014
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Provider Practice Location Address
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Address Line | 3512 S ATLANTIC BLVD
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City | DAYTONA BEACH SHORES
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State | FL
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Zip | 32118
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Country | US
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Telephone | 386-767-9544
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Fax |
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Provider Business Mailing Address
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Address Line | 3512 S ATLANTIC AVE
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City | DAYTONA BEACH SHORES
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State | FL
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Zip | 32118-7639
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Country | US
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Telephone | 386-767-9544
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. GERALD WOODARD
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Credential |
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Telephone | 386-767-9544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | ARNP 3088302
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License Number State | FL
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