Basic Information
| Provider Information | |||||||||
| NPI: | 1407050644 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | OB-GYN HEALTH CENTER P A | ||||||||
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| OtherOrganizationName: | OB-GYN HEALTH CENTER P A | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1445 DUNN AVE | ||||||||
| Address2: | |||||||||
| City: | DAYTONA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321141437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3862580123 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1445 DUNN AVE | ||||||||
| Address2: | |||||||||
| City: | DAYTONA BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 321141437 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3862580123 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/12/2007 | ||||||||
| LastUpdateDate: | 02/14/2008 | ||||||||
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| AuthorizedOfficialLastName: | MEYERS | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | C | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3862580123 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.