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General NPI Number Information
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NPI Number | 1609637420
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Entity Type | Organization
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Legal Business Name | MEDXCLUSIVE, LLC
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Dates
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Enumeration Date | 01/18/2024
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Last Update Date | 02/22/2024
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Provider Practice Location Address
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Address Line | 3320 THOMASVILLE RD STE 302
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City | TALLAHASSEE
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State | FL
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Zip | 32308-7971
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Country | US
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Telephone | 734-812-3939
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Fax |
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Provider Business Mailing Address
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Address Line | 3320 THOMASVILLE RD STE 302
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City | TALLAHASSEE
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State | FL
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Zip | 32308-7971
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Country | US
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Telephone | 734-812-3939
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | SHELBY HOPKINS VANDERLAN
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Credential |
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Telephone | 734-812-3939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number |
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License Number State |
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