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General NPI Number Information
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NPI Number | 1740673300
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Entity Type | Organization
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Legal Business Name | AFERMIN PRIMARY CARE PA
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Dates
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Enumeration Date | 03/06/2015
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Last Update Date | 03/28/2018
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Provider Practice Location Address
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Address Line | 2089 S RIDGEWOOD AVE
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City | SOUTH DAYTONA
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State | FL
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Zip | 32119-2240
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Country | US
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Telephone | 386-767-7533
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Fax |
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Provider Business Mailing Address
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Address Line | 500 MEMORIAL CIR STE A
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City | ORMOND BEACH
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State | FL
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Zip | 32174-5054
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Country | US
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Telephone | 386-334-1295
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | DR. PATRICK JOHN LARRAZABAL
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Credential | M.D.
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Telephone | 386-334-1295
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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 | ME0086562
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME0020477
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License Number State | FL
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