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General NPI Number Information
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NPI Number | 1942270905
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Entity Type | Organization
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Legal Business Name | E & M MEDICAL SERVICES
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Dates
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Enumeration Date | 01/24/2006
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Last Update Date | 03/22/2011
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Provider Practice Location Address
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Address Line | 10383 HAMPTON AVE
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City | STARKE
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State | FL
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Zip | 32091-7843
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Country | US
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Telephone | 352-468-1735
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Fax | 352-468-1739
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Provider Business Mailing Address
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Address Line | 10383 HAMPTON AVE
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City | STARKE
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State | FL
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Zip | 32091-7843
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Country | US
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Telephone | 352-468-1735
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Fax | 352-468-1739
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | DR. JOELLE M INNOCENT-SIMON
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Credential | D.O.
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Telephone | 352-468-1735
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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 | OS0006902
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License Number State | FL
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