| Florida Internal Medicine Pa | |
|
4106 W Lake Mary Blvd Suite 301 Lake Mary FL 32746-3315 | |
| (407) 333-2503 | |
| (407) 333-0962 |
| Full Name | Florida Internal Medicine Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 4106 W Lake Mary Blvd, Lake Mary, Florida |
| Authorized Official Name and Position | Glen F Davis (PRESIDENT) |
| Authorized Official Contact | 4073332503 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Florida Internal Medicine Pa 4106 W Lake Mary Blvd Suite 301 Lake Mary FL 32746-3315 Ph: (407) 333-2503 | Florida Internal Medicine Pa 4106 W Lake Mary Blvd Suite 301 Lake Mary FL 32746-3315 Ph: (407) 333-2503 |
| NPI Number | 1831136274 |
|---|---|
| Provider Enumeration Date | 06/02/2006 |
| Last Update Date | 08/23/2007 |
| Medicare PECOS PAC ID | 8022100080 |
|---|---|
| Medicare Enrollment ID | O20070822000643 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1831136274 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
| Provider Name | Glen F. Davis |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1689617813 PECOS PAC ID: 0042302036 Enrollment ID: I20100914000979 |
| Provider Name | John F. Ryan |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1144266974 PECOS PAC ID: 3678665668 Enrollment ID: I20101011000396 |
| Provider Name | Nicole Kristine Rodriguez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1609346378 PECOS PAC ID: 8820330806 Enrollment ID: I20190423000346 |
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