Provider Demographics
NPI:1003084997
Name:TEQUESTA FAMILY PRACTICE PA
Entity Type:Organization
Organization Name:TEQUESTA FAMILY PRACTICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:J
Authorized Official - Last Name:OENBRINK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-746-4333
Mailing Address - Street 1:395 B TEQUESTA DR
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33458-3053
Mailing Address - Country:US
Mailing Address - Phone:561-746-4333
Mailing Address - Fax:561-746-4449
Practice Address - Street 1:395 B TEQUESTA DR
Practice Address - Street 2:
Practice Address - City:TEQUESTA
Practice Address - State:FL
Practice Address - Zip Code:33458-3053
Practice Address - Country:US
Practice Address - Phone:561-746-4333
Practice Address - Fax:561-746-4449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-14
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5132207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK1217OtherMEDICARE GROUP ID
FLK1217OtherMEDICARE GROUP ID