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4690 S Clyde Morris Blvd Port Orange FL 32129-7450 | |
| (386) 767-7885 | |
| (386) 767-3559 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 4690 S Clyde Morris Blvd, Port Orange, Florida |
| Authorized Official Name and Position | Donna M Deleno (OFFICE MANAGER) |
| Authorized Official Contact | 3867677885 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4690 S Clyde Morris Blvd Port Orange FL 32129-7450 Ph: (386) 767-7885 | 4690 S Clyde Morris Blvd Port Orange FL 32129-7450 Ph: (386) 767-7885 |
| NPI Number | 1265732697 |
|---|---|
| Provider Enumeration Date | 11/02/2010 |
| Last Update Date | 11/02/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265732697 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Primary |
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