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General NPI Number Information
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NPI Number | 1801054036
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Entity Type | Organization
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Legal Business Name | DR BEHAL'S FAMILY PRACTICE CLINIC
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Dates
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Enumeration Date | 05/23/2008
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Last Update Date | 05/23/2008
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Provider Practice Location Address
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Address Line | 1138 CARLTON AVE
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City | LAKE WALES
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State | FL
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Zip | 33853-4305
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Country | US
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Telephone | 863-678-9900
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Fax | 863-678-9278
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Provider Business Mailing Address
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Address Line | 1138 CARLTON AVE
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City | LAKE WALES
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State | FL
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Zip | 33853-4305
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Country | US
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Telephone | 863-678-9900
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Fax | 863-678-9278
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Authorized Official
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Title or Position | MANAGER
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Name | TERENCE D' VAZ
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Credential |
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Telephone | 863-232-5062
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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 | ME91856
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License Number State | FL
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