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General NPI Number Information
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NPI Number | 1306067509
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Entity Type | Organization
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Legal Business Name | TEQUESTA HEALTH CENTER, INC
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Dates
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Enumeration Date | 05/02/2007
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Last Update Date | 01/11/2011
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Provider Practice Location Address
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Address Line | 169 TEQUESTA DR SUITE 12E
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City | TEQUESTA
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State | FL
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Zip | 33469-2768
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Country | US
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Telephone | 561-747-7672
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Fax | 561-743-3667
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Provider Business Mailing Address
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Address Line | 169 TEQUESTA DR SUITE 12E
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City | TEQUESTA
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State | FL
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Zip | 33469-2768
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Country | US
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Telephone | 561-747-7672
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Fax | 561-743-3667
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Authorized Official
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Title or Position | PHYSICIAN MANAGER
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Name | DR. MARK L CORRY
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Credential | M.D
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Telephone | 561-747-7672
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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 | FL
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