=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992989883
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MEDSTOP PL LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/27/2007
-----------------------------------------------------
Last Update Date | 12/27/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3003 STATE HIGHWAY 77 SUITE A
-----------------------------------------------------
City | LYNN HAVEN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32444
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-248-3030
-----------------------------------------------------
Fax | 850-248-3039
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 1930
-----------------------------------------------------
City | LYNN HAVEN
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32444-6930
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 850-277-1788
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. LUIS GALANO-LAVIN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 850-248-3030
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME 88914
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------