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General NPI Number Information
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NPI Number | 1770867269
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Entity Type | Organization
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Legal Business Name | NORDQUIST FAMILY MEDICAL CENTER MD PA
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Dates
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Enumeration Date | 10/04/2011
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Last Update Date | 10/04/2011
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Provider Practice Location Address
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Address Line | 1925 DON WICKHAM DR
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City | CLERMONT
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State | FL
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Zip | 34711-1915
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Country | US
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Telephone | 352-638-7900
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Fax | 877-444-2394
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Provider Business Mailing Address
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Address Line | 1925 DON WICKHAM DR
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City | CLERMONT
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State | FL
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Zip | 34711-1915
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Country | US
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Telephone | 352-638-7900
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Fax | 877-444-2394
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Authorized Official
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Title or Position | PRESIDENT
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Name | CLAY E NORDQUIST
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Credential | MD
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Telephone | 352-638-7900
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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 | ME103291
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License Number State | FL
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