Basic Information
| Provider Information | |||||||||
| NPI: | 1710417662 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | P& T FAMILY CARE LLC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | P& T FAMILY CARE LLC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1403 MEDICAL PLAZA DR STE 106 | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327711085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073281575 | ||||||||
| FaxNumber: | 4073281577 | ||||||||
| Practice Location | |||||||||
| Address1: | 1403 MEDICAL PLAZA DR STE 106 | ||||||||
| Address2: | |||||||||
| City: | SANFORD | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327711085 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073281575 | ||||||||
| FaxNumber: | 4073281577 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | JANI | ||||||||
| AuthorizedOfficialFirstName: | PRASHANT | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 8287853764 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.