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General NPI Number Information
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NPI Number | 1487825428
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Entity Type | Organization
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Legal Business Name | ATLANTIC ENDOCRINE ASSOCIATES P A
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Dates
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Enumeration Date | 03/18/2008
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Last Update Date | 03/28/2012
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Provider Practice Location Address
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Address Line | 1360 MASON AVE SUITE C
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-5529
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Country | US
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Telephone | 386-255-6241
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Fax |
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Provider Business Mailing Address
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Address Line | 1360 MASON AVE SUITE C
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City | DAYTONA BEACH
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State | FL
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Zip | 32117-5529
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Country | US
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Telephone | 386-255-6241
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | RICHARD DAVID MORRIS
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Credential | MD
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Telephone | 386-255-6241
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME42683
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License Number State | FL
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