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General NPI Number Information
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NPI Number | 1760596431
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Entity Type | Organization
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Legal Business Name | WOMEN'S CARE OF CLERMONT PA
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Dates
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Enumeration Date | 08/18/2006
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Last Update Date | 06/26/2012
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Provider Practice Location Address
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Address Line | 1725 E HIGHWAY 50 SUITE B
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City | CLERMONT
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State | FL
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Zip | 34711-5188
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Country | US
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Telephone | 352-243-6686
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Fax | 352-243-2414
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Provider Business Mailing Address
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Address Line | 1725 E HIGHWAY 50 SUITE B
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City | CLERMONT
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State | FL
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Zip | 34711-5188
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Country | US
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Telephone | 352-243-6686
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Fax | 352-243-2414
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Authorized Official
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Title or Position | OWNER
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Name | SHELLEY COLEMAN GLOVER
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Credential | MD
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Telephone | 352-243-6686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME81410
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License Number State | FL
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