Basic Information
| Provider Information | |||||||||
| NPI: | 1346414919 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DOCTORS URGENT CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2404 US HIGHWAY 19 | ||||||||
| Address2: | |||||||||
| City: | HOLIDAY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346913943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7279450100 | ||||||||
| FaxNumber: | 7279450133 | ||||||||
| Practice Location | |||||||||
| Address1: | 2404 US HIGHWAY 19 | ||||||||
| Address2: | |||||||||
| City: | HOLIDAY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346913943 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7279450100 | ||||||||
| FaxNumber: | 7249450133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/15/2008 | ||||||||
| LastUpdateDate: | 07/12/2021 | ||||||||
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| AuthorizedOfficialLastName: | DEAN | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | BAHMAN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 7273591171 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | 07/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | ME78794 | FL | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
No ID Information.