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General NPI Number Information
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NPI Number | 1518493667
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Entity Type | Organization
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Legal Business Name | INFECTIOUS DISEASES & TROPICAL MEDICINE PA
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 05/11/2017
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Provider Practice Location Address
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Address Line | 800 ZEAGLER DR SUITE 210
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City | PALATKA
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State | FL
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Zip | 32177-3883
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Country | US
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Telephone | 904-471-9633
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Fax | 904-471-8808
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Provider Business Mailing Address
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Address Line | 800 ZEAGLER DR SUITE 210
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City | PALATKA
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State | FL
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Zip | 32177-3883
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Country | US
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Telephone | 904-471-9633
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Fax | 904-471-8808
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. VICENTE MACO
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Credential | MD
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Telephone | 904-471-9633
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number | ME117467
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License Number State | FL
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