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General NPI Number Information
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NPI Number | 1861574634
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Entity Type | Organization
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Legal Business Name | DOCTORS WELLNES CLINIC
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 06/21/2010
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Provider Practice Location Address
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Address Line | 13133 66TH ST
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City | LARGO
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State | FL
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Zip | 33773-1812
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Country | US
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Telephone | 727-330-7743
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Fax | 727-330-7745
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Provider Business Mailing Address
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Address Line | 13133 66TH ST
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City | LARGO
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State | FL
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Zip | 33773-1812
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Country | US
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Telephone | 727-330-7743
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Fax | 727-330-7745
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Authorized Official
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Title or Position | PRESIDENT
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Name | MIKE PAUL LINKOUS
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Credential | PA-C
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Telephone | 727-330-7743
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA9101571
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License Number State | FL
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