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General NPI Number Information
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NPI Number | 1326335050
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Entity Type | Organization
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Legal Business Name | ABC PEDIATRICS
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Dates
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Enumeration Date | 07/01/2011
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Last Update Date | 07/01/2011
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Provider Practice Location Address
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Address Line | 1403 CATMAR RD
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City | NICEVILLE
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State | FL
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Zip | 32578-9742
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Country | US
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Telephone | 850-689-0900
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Fax |
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Provider Business Mailing Address
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Address Line | 1403 CATMAR RD
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City | NICEVILLE
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State | FL
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Zip | 32578-9742
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Country | US
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Telephone | 850-689-0900
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Fax |
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Authorized Official
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Title or Position | MD
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Name | DR. LUIS F GOMEZ
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Credential | MD
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Telephone | 850-689-0900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State | FL
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