Basic Information
| Provider Information | |||||||||
| NPI: | 1023256096 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WOMENS HEALTH ASSOCIATES OF HERNANDO PLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5189 | ||||||||
| Address2: | |||||||||
| City: | SPRING HILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346115189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525565241 | ||||||||
| FaxNumber: | 3525565244 | ||||||||
| Practice Location | |||||||||
| Address1: | 11373 CORTEZ BLVD | ||||||||
| Address2: | SUITE 408 | ||||||||
| City: | BROOKSVILLE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346135414 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3525565241 | ||||||||
| FaxNumber: | 3525565244 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/29/2009 | ||||||||
| LastUpdateDate: | 01/30/2009 | ||||||||
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| AuthorizedOfficialLastName: | MARLER | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | F | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3525565241 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | ME 74253 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
ID Information
| ID | Type | State | Issuer | Description | ME 74253 | 01 | FL | MEDICAL LICENSE | OTHER |