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General NPI Number Information
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NPI Number | 1396099883
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Entity Type | Organization
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Legal Business Name | TEQUESTA FAMILY MEDICAL CENTER, LLC
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Dates
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Enumeration Date | 11/05/2012
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Last Update Date | 11/05/2012
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Provider Practice Location Address
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Address Line | 851 N US HIGHWAY 1
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City | TEQUESTA
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State | FL
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Zip | 33469-2348
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Country | US
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Telephone | 561-743-8362
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Fax |
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Provider Business Mailing Address
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Address Line | 851 N US HIGHWAY 1
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City | TEQUESTA
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State | FL
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Zip | 33469-2348
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Country | US
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Telephone | 561-743-8362
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MARK LANGE CORRY
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Credential | M.D.
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Telephone | 561-743-8362
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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 | ME78193
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License Number State | FL
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