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General NPI Number Information
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NPI Number | 1295106334
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Entity Type | Organization
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Legal Business Name | DOC PAM, PA
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Dates
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Enumeration Date | 10/15/2015
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 201 N LAKEMONT AVE SUITE 200
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City | WINTER PARK
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State | FL
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Zip | 32792-3228
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Country | US
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Telephone | 321-203-4410
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Fax | 321-203-4409
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Provider Business Mailing Address
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Address Line | 1719 LOCH BERRY RD
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City | WINTER PARK
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State | FL
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Zip | 32789-5221
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Country | US
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Telephone | 321-662-2043
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Fax | 321-203-4409
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Authorized Official
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Title or Position | PRESIDENT
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Name | PAMELA CHRISTINE TROUT
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Credential | MD
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Telephone | 321-662-2043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | ME94271
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License Number State | FL
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