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General NPI Number Information
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NPI Number | 1427415264
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Entity Type | Organization
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Legal Business Name | MEDAPRIME, INC
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Dates
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Enumeration Date | 01/25/2016
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Last Update Date | 01/25/2016
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Provider Practice Location Address
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Address Line | 10199 CLEARY BLVD SUITE 8
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City | PLANTATION
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State | FL
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Zip | 33324-1029
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Country | US
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Telephone | 954-644-1430
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Fax |
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Provider Business Mailing Address
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Address Line | 10199 CLEARY BLVD SUITE 8
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City | PLANTATION
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State | FL
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Zip | 33324-1029
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Country | US
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Telephone | 954-644-1430
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Fax |
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Authorized Official
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Title or Position | PSTD
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Name | FRANK C HERNANDEZ
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Credential |
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Telephone | 954-644-1430
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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 | ME40710
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License Number State | FL
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