Provider Demographics
NPI:1164526273
Name:NORTH COUNTY MEDICAL LLC
Entity Type:Organization
Organization Name:NORTH COUNTY MEDICAL LLC
Other - Org Name:NORTH COUNTY MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:DEPUTRON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:772-581-6900
Mailing Address - Street 1:PO BOX 220
Mailing Address - Street 2:
Mailing Address - City:ROSELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32957-0220
Mailing Address - Country:US
Mailing Address - Phone:772-581-6900
Mailing Address - Fax:772-581-3395
Practice Address - Street 1:13838 US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-3296
Practice Address - Country:US
Practice Address - Phone:772-581-6900
Practice Address - Fax:772-581-3395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL622483OtherTRIGON
FL45938OtherBCBS FLORID
PA1390193OtherBCBS PA
FL622483OtherTRIGON
FLCJ4104Medicare ID - Type UnspecifiedRR MEDICARE
FL622483OtherTRIGON