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General NPI Number Information
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NPI Number | 1316151194
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Entity Type | Organization
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Legal Business Name | A E DEEB MD PA
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Dates
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Enumeration Date | 05/10/2007
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Last Update Date | 03/26/2008
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Provider Practice Location Address
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Address Line | 1630 N PLAZA DR
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5346
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Country | US
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Telephone | 850-877-6324
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Fax |
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Provider Business Mailing Address
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Address Line | 1630 N PLAZA DR
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5346
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Country | US
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Telephone | 850-877-6324
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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. AL ELIAS DEEB
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Credential | M.D.
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Telephone | 850-877-6324
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 25682
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License Number State | FL
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