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General NPI Number Information
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NPI Number | 1225046626
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Entity Type | Organization
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Legal Business Name | DAYTONA BEACH VA OUTPAITENT CLINIC
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Dates
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Enumeration Date | 08/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 551 NATIONAL HEALTH CARE DR
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City | DAYTONA BEACH
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State | FL
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Zip | 32114-1495
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Country | US
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Telephone | 386-323-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 6810 PLUMPJACK CT
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City | PORT ORANGE
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State | FL
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Zip | 32128-4083
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Country | US
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Telephone | 386-233-9774
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Fax |
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. ROGER H. BOWER
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Credential |
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Telephone | 386-323-7542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | ME 88745
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License Number State | FL
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