Provider Demographics
NPI:1003262585
Name:INTEGRATIVE PRIMARY CARE DOCTOR
Entity Type:Organization
Organization Name:INTEGRATIVE PRIMARY CARE DOCTOR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ACUPUNCTURE PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:WALSH
Authorized Official - Suffix:
Authorized Official - Credentials:DOM, AP
Authorized Official - Phone:407-435-9683
Mailing Address - Street 1:450 SAINT CHARLES CT STE 1000
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-2176
Mailing Address - Country:US
Mailing Address - Phone:407-833-3800
Mailing Address - Fax:
Practice Address - Street 1:450 SAINT CHARLES COURT
Practice Address - Street 2:SUITE 1000
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-7626
Practice Address - Country:US
Practice Address - Phone:407-833-3800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-13
Last Update Date:2016-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP3693171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty