MEDICARE: FLORIDA PRIMARY PHYSICIANS

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	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	24055	OTHER	FL	BLUE CROSS AND BLUE SHIEL

General Provider Information

NPI Number	:	1669412458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDA PRIMARY PHYSICIANS

Provider Business Mailing Address
First Line	:	4101 NW 4TH ST
Second Line	:	SUITE 104
City	:	PLANTATION
State	:	FL
Zip	:	33317-2850
Country	:	US
Telephone Number	:	954-587-3805
Fax Number	:

Provider Business Practice Location Address
First Line	:	4101 NW 4TH ST
Second Line	:	SUITE 104
City	:	PLANTATION
State	:	FL
Zip	:	33317-2850
Country	:	US
Telephone Number	:	954-587-3805
Fax Number	:

Authorized Official
Title or Position	:	VP
Name	:	GARY DUNCAN
Credential	:
Telephone Number	:	561-548-1089

Provider Enumeration Date	:	06/08/2006
Last Update Date	:	08/28/2007

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