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NPI Code Detail

MEDICARE: DESTIN PRIMARY CARE LLC

MEDICARE: DESTIN PRIMARY CARE LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician

General Provider Information

NPI Number : 1275601023
Entity Type Code : Organization
Provider Name (Legal Business Name) : DESTIN PRIMARY CARE LLC
Provider Business Mailing Address
First Line : 996 AIRPORT RD
Second Line :
City : DESTIN
State : FL
Zip : 32541-2824
Country : US
Telephone Number : 850-837-5562
Fax Number : 850-837-6085
Provider Business Practice Location Address
First Line : 996 AIRPORT RD
Second Line : SUITE E 103
City : DESTIN
State : FL
Zip : 32541-2824
Country : US
Telephone Number : 850-837-5562
Fax Number : 850-837-6085
Authorized Official
Title or Position : OFFICE MANAGER
Name : JO LUCIDO
Credential :
Telephone Number : 850-837-5562
Provider Enumeration Date : 12/01/2006
Last Update Date : 08/22/2020

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Directions to “DESTIN PRIMARY CARE LLC ” Practice Location

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