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General NPI Number Information
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NPI Number | 1699104620
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Entity Type | Organization
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Legal Business Name | MITCH P. FEARING MD, PA
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Dates
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Enumeration Date | 11/12/2013
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Last Update Date | 11/12/2013
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Provider Practice Location Address
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Address Line | 14819 NW 140TH ST
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City | ALACHUA
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State | FL
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Zip | 32615-2600
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Country | US
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Telephone | 386-462-1327
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Fax | 386-462-1328
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Provider Business Mailing Address
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Address Line | 14819 NW 140TH ST
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City | ALACHUA
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State | FL
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Zip | 32615-2600
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Country | US
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Telephone | 386-462-1327
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Fax | 386-462-1328
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Authorized Official
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Title or Position | DR./OWNER
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Name | MITCHEL P. FEARING
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Credential | MD
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Telephone | 386-462-1327
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | ME51798
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License Number State | FL
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