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General NPI Number Information
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NPI Number | 1609894484
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Entity Type | Organization
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Legal Business Name | WESTON MEDICAL CLINIC INC
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Dates
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Enumeration Date | 07/18/2006
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Last Update Date | 08/30/2010
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Provider Practice Location Address
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Address Line | 17120 ROYAL PALM BLVD SUITE 4
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City | WESTON
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State | FL
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Zip | 33326-2310
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Country | US
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Telephone | 954-385-3711
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Fax | 954-385-9366
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Provider Business Mailing Address
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Address Line | 17120 ROYAL PALM BLVD SUITE 4
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City | WESTON
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State | FL
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Zip | 33326-2310
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Country | US
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Telephone | 954-385-3711
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Fax | 954-385-9366
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Authorized Official
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Title or Position | PRESIDENT
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Name | PHANOR CALLE
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Credential | M.D.
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Telephone | 954-385-9711
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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 | ME0073727
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License Number State | FL
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