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General NPI Number Information
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NPI Number | 1912980632
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Entity Type | Organization
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Legal Business Name | PRIMARY CARE SPECIALISTS LLC
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Dates
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Enumeration Date | 11/28/2005
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Last Update Date | 11/18/2011
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Provider Practice Location Address
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Address Line | 3615 S ORANGE AVE
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City | ORLANDO
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State | FL
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Zip | 32806-6216
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Country | US
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Telephone | 407-855-2526
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Fax | 407-855-1503
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Provider Business Mailing Address
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Address Line | 3615 S ORANGE AVE
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City | ORLANDO
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State | FL
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Zip | 32806-6216
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Country | US
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Telephone | 407-855-2526
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Fax | 407-855-1503
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Authorized Official
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Title or Position | PARTNER
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Name | GERALD J KIVETT
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Credential | MD
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Telephone | 407-275-9014
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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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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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