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General NPI Number Information
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NPI Number | 1558653253
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Entity Type | Organization
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Legal Business Name | ST ANTHONY'S FAMILY MEDICAL PRACTICE MD PA
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Dates
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Enumeration Date | 05/12/2011
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Last Update Date | 09/29/2012
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Provider Practice Location Address
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Address Line | 1584 CITRUS MEDICAL CT
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City | OCOEE
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State | FL
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Zip | 34761-4547
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Country | US
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Telephone | 407-512-6401
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Fax |
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Provider Business Mailing Address
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Address Line | 1584 CITRUS MEDICAL CT
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City | OCOEE
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State | FL
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Zip | 34761-4547
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Country | US
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Telephone | 407-512-6401
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Fax | 407-512-6405
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Authorized Official
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Title or Position | MANAGER
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Name | AMY WHITE
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Credential |
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Telephone | 407-512-6401
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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 | ME70004
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License Number State | FL
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