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General NPI Number Information
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NPI Number | 1639277502
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Entity Type | Organization
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Legal Business Name | FIRST PRIMARY CARE & FAMILY MEDICINE INC
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Dates
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Enumeration Date | 09/21/2006
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Last Update Date | 07/02/2013
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Provider Practice Location Address
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Address Line | 2587 WOODGROVE RD
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-4974
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Country | US
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Telephone | 904-264-0286
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Fax | 904-264-0296
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Provider Business Mailing Address
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Address Line | 2587 WOODGROVE RD
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City | FLEMING ISLAND
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State | FL
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Zip | 32003-4974
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Country | US
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Telephone | 904-264-0286
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Fax | 904-264-0296
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. HUI TANG
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Credential | MD
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Telephone | 904-264-0286
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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 | ME85064
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 335V00000X
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Taxonomy Name | Portable X-ray and/or Other Portable Diagnostic Imaging Supplier
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License Number | HCC7670
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License Number State | FL
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