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General NPI Number Information
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NPI Number | 1982747838
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Entity Type | Organization
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Legal Business Name | SOUTHEASTERN CENTER FOR INFECTIOUS DISEASES PA
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Dates
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Enumeration Date | 02/14/2007
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Last Update Date | 10/26/2011
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Provider Practice Location Address
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Address Line | 2009 MICCOSUKEE RD
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5359
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Country | US
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Telephone | 850-942-2299
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Fax | 850-942-0322
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Provider Business Mailing Address
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Address Line | 2009 MICCOSUKEE RD
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5359
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Country | US
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Telephone | 850-942-2299
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Fax | 850-942-0322
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. PHILBERT J FORD
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Credential | M.D.
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Telephone | 850-942-2299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME91513
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License Number State | FL
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