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General NPI Number Information
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NPI Number | 1396138319
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Entity Type | Organization
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Legal Business Name | PREMIER PHYSICIAN ASSOCIATES LLC
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Dates
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Enumeration Date | 03/16/2015
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Last Update Date | 03/16/2015
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Provider Practice Location Address
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Address Line | 13651 HUNTERS OAK DR STE 101
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City | ORLANDO
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State | FL
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Zip | 32837-7679
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Country | US
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Telephone | 321-946-6864
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2648
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City | ORLANDO
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State | FL
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Zip | 32802-2648
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Country | US
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Telephone | 321-946-6864
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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. VIOLA JACOBS
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Credential | MD
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Telephone | 321-946-6864
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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 | ME85807
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME90116
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License Number State | FL
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