Basic Information
| Provider Information | |||||||||
| NPI: | 1710239694 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | YOUR FAMILY DOCTOR, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11077 SPRING HILL DR | ||||||||
| Address2: | |||||||||
| City: | SPRING HILL | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346085000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3526843300 | ||||||||
| FaxNumber: | 3526843222 | ||||||||
| Practice Location | |||||||||
| Address1: | 13028 COUNTY LINE RD | ||||||||
| Address2: | |||||||||
| City: | HUDSON | ||||||||
| State: | FL | ||||||||
| PostalCode: | 346676421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7278623591 | ||||||||
| FaxNumber: | 7278637034 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2012 | ||||||||
| LastUpdateDate: | 10/03/2012 | ||||||||
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| AuthorizedOfficialLastName: | MALHOTRA | ||||||||
| AuthorizedOfficialFirstName: | GAURAV | ||||||||
| AuthorizedOfficialMiddleName: | V | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3525848524 | ||||||||
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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 | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.