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General NPI Number Information
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NPI Number | 1437467867
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Entity Type | Organization
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Legal Business Name | EB LAND INVESTMENT LLC
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Dates
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Enumeration Date | 09/20/2010
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Last Update Date | 03/14/2013
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Provider Practice Location Address
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Address Line | 2331 NORTH STATE RD 7 206
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33313-3748
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Country | US
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Telephone | 954-677-0393
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Fax | 866-862-4675
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Provider Business Mailing Address
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Address Line | 2331 N STATE ROAD 7 206
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City | LAUDERDALE LAKES
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State | FL
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Zip | 33313-3748
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Country | US
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Telephone | 954-677-0393
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Fax | 866-862-4675
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Authorized Official
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Title or Position | PROVIDER
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Name | DR. ERIC BELIZAIRE
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Credential | M.D.
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Telephone | 954-677-0393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | ME88781
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License Number State | FL
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