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General NPI Number Information
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NPI Number | 1366992463
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Entity Type | Organization
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Legal Business Name | PHYSICIANS OF MID FLORIDA LLC
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Dates
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Enumeration Date | 10/12/2016
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Last Update Date | 10/12/2016
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Provider Practice Location Address
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Address Line | 1936 BRUCE B DOWNS BLVD
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-9262
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Country | US
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Telephone | 352-409-5076
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Fax |
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Provider Business Mailing Address
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Address Line | 1936 BRUCE B DOWNS BLVD
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City | WESLEY CHAPEL
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State | FL
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Zip | 33544-9262
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Country | US
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Telephone | 352-409-5076
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Fax |
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Authorized Official
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Title or Position | MBR
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Name | GHULAM M ANWAR
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Credential | M.D
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Telephone | 352-409-5076
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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 | ME109130
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License Number State | FL
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