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509 Cagan View Rd Clermont FL 34714-6405 | |
| (407) 905-8827 | |
| (407) 905-8827 |
| Full Name | |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 509 Cagan View Rd, Clermont, Florida |
| Authorized Official Name and Position | Mark W Dickinson (CFO) |
| Authorized Official Contact | 4079058827 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
110 S Woodland St Winter Garden FL 34787-3546 Ph: (407) 905-8227 | 509 Cagan View Rd Clermont FL 34714-6405 Ph: (407) 905-8827 |
| NPI Number | 1922617695 |
|---|---|
| Provider Enumeration Date | 07/28/2020 |
| Last Update Date | 04/21/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1922617695 | NPI | - | NPPES |
| 261QP2300X | Other | TAXONOMY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | (* (Not Available)) | Primary |
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