Basic Information
| Provider Information | |||||||||
| NPI: | 1265512578 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | AMERICAN MEDIC OF CHARLOTTE COUNTY PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2343 AARON ST | ||||||||
| Address2: | |||||||||
| City: | PORT CHARLOTTE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339525305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9416292900 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2343 AARON ST | ||||||||
| Address2: | |||||||||
| City: | PORT CHARLOTTE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339525305 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9416292900 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/17/2006 | ||||||||
| LastUpdateDate: | 06/05/2008 | ||||||||
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| AuthorizedOfficialLastName: | MYERS | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | PHYSICIAN | ||||||||
| AuthorizedOfficialTelephone: | 9416391719 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | ME0034700 | FL | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.