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General NPI Number Information
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NPI Number | 1598827479
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Entity Type | Organization
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Legal Business Name | MID FLORIDA PRIMARY CARE PA
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 05/02/2013
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Provider Practice Location Address
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Address Line | 401 NORTH BLVD W
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City | LEESBURG
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State | FL
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Zip | 34748-5044
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Country | US
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Telephone | 352-728-4242
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Fax | 352-728-4868
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Provider Business Mailing Address
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Address Line | 401 NORTH BLVD W
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City | LEESBURG
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State | FL
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Zip | 34748-5044
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Country | US
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Telephone | 352-728-4242
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Fax | 352-728-4868
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Authorized Official
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Title or Position | PRESIDENT
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Name | RAVI P GUPTA
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Credential | M.D.
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Telephone | 352-728-4242
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME71724
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License Number State | FL
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