MEDICARE: FIRST PATIENT CARE CLINIC @ DAVIE

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
1	261QP2300X	Primary Care Clinic/Center

General Provider Information

NPI Number	:	1306652995
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIRST PATIENT CARE CLINIC @ DAVIE

Provider Business Mailing Address
First Line	:	3228 DAVIE BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-2766
Country	:	US
Telephone Number	:	954-533-4508
Fax Number	:

Provider Business Practice Location Address
First Line	:	3228 DAVIE BLVD
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33312-2766
Country	:	US
Telephone Number	:	954-533-4508
Fax Number	:	561-266-3447

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	GUERRY FAUSTIN
Credential	:
Telephone Number	:	561-266-3487

Provider Enumeration Date	:	12/09/2024
Last Update Date	:	12/09/2024

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