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General NPI Number Information
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NPI Number | 1821422528
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Entity Type | Organization
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Legal Business Name | HARBOR PRIMARY CARE PA
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Dates
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Enumeration Date | 08/29/2013
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Last Update Date | 08/29/2013
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Provider Practice Location Address
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Address Line | 1300 36TH ST SUITE G, MEDICAL ARTS CENTER
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City | VERO BEACH
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State | FL
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Zip | 32960-4898
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Country | US
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Telephone | 772-519-9066
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Fax |
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Provider Business Mailing Address
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Address Line | 4229 DIAMOND SQ
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City | VERO BEACH
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State | FL
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Zip | 32967-1840
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | THET TUN
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Credential | MD
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Telephone | 772-519-9066
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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 |
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License Number State |
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