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General NPI Number Information
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NPI Number | 1902592207
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Entity Type | Organization
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Legal Business Name | PREMIER PHYSICIAN CONSULTING
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Dates
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Enumeration Date | 04/11/2023
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Last Update Date | 04/11/2023
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Provider Practice Location Address
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Address Line | 1270 REED CANAL RD APT 6308
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City | PORT ORANGE
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State | FL
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Zip | 32129-9188
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Country | US
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Telephone | 386-341-8886
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Fax |
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Provider Business Mailing Address
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Address Line | 1270 REED CANAL RD APT 6308
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City | PORT ORANGE
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State | FL
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Zip | 32129-9188
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Country | US
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Telephone | 386-341-8886
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DELICIA HAYNES
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Credential | MD
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Telephone | 386-310-2052
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202D00000X
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Taxonomy Name | Integrative Medicine Physician
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License Number |
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License Number State |
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