Basic Information
| Provider Information | |||||||||
| NPI: | 1598827479 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MID FLORIDA PRIMARY CARE PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 NORTH BLVD W | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347485044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527284242 | ||||||||
| FaxNumber: | 3527284868 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 NORTH BLVD W | ||||||||
| Address2: | |||||||||
| City: | LEESBURG | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347485044 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3527284242 | ||||||||
| FaxNumber: | 3527284868 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/15/2006 | ||||||||
| LastUpdateDate: | 05/02/2013 | ||||||||
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| AuthorizedOfficialLastName: | GUPTA | ||||||||
| AuthorizedOfficialFirstName: | RAVI | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3527284242 | ||||||||
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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 | 207R00000X | ME71724 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.