Provider Demographics
NPI:1043758782
Name:A PREMIER MEDICAL RESEARCH OF FLORIDA L.L.C
Entity Type:Organization
Organization Name:A PREMIER MEDICAL RESEARCH OF FLORIDA L.L.C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:TATAW
Authorized Official - Last Name:BESONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-747-9771
Mailing Address - Street 1:2111 HONTOON RD
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-4308
Mailing Address - Country:US
Mailing Address - Phone:386-747-9771
Mailing Address - Fax:
Practice Address - Street 1:2728 ENTERPRISE RD STE 200
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8276
Practice Address - Country:US
Practice Address - Phone:386-747-9771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-01
Last Update Date:2017-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207L00000X, 207Q00000X, 207R00000X
FLME074829207LP2900X
FLME92729207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty