MEDICARE: DUNLAWTON FAMILY MEDICINE PLC

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	:	1629061767
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DUNLAWTON FAMILY MEDICINE PLC

Provider Business Mailing Address
First Line	:	790 DUNLAWTON AVE
Second Line	:	SUITE E
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4222
Country	:	US
Telephone Number	:	386-760-1877
Fax Number	:	386-760-2791

Provider Business Practice Location Address
First Line	:	790 DUNLAWTON AVE
Second Line	:	SUITE E
City	:	PORT ORANGE
State	:	FL
Zip	:	32127-4222
Country	:	US
Telephone Number	:	386-760-1877
Fax Number	:	386-760-2791

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARK DAVID KENDRICK
Credential	:	M.D.
Telephone Number	:	386-760-1877

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	06/20/2012

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