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General NPI Number Information
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NPI Number | 1376181446
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Entity Type | Organization
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Legal Business Name | LIBERTY PHYSICIANS ASSOCIATES INC
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Dates
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Enumeration Date | 12/19/2019
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Last Update Date | 12/19/2019
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Provider Practice Location Address
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Address Line | 1250 W STATE ROAD 434 STE 1016
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City | LONGWOOD
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State | FL
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Zip | 32750-4969
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Country | US
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Telephone | 833-438-0008
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Fax |
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Provider Business Mailing Address
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Address Line | 1250 W STATE ROAD 434 STE 1016
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City | LONGWOOD
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State | FL
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Zip | 32750-4969
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Country | US
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Telephone | 833-438-0008
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Fax |
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Authorized Official
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Title or Position | MANAGING DIRECTOR
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Name | OLADIMEJI J ADEKUNLE
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Credential |
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Telephone | 833-438-0008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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