Provider Demographics
NPI:1235315946
Name:DR. DAVID G. FLORENCE
Entity Type:Organization
Organization Name:DR. DAVID G. FLORENCE
Other - Org Name:MEDICAL ENTERPRISES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:G
Authorized Official - Last Name:FLORENCE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:931-728-5522
Mailing Address - Street 1:PO BOX 749
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:TN
Mailing Address - Zip Code:37349-0749
Mailing Address - Country:US
Mailing Address - Phone:931-728-5522
Mailing Address - Fax:931-728-2247
Practice Address - Street 1:804 KEYLON ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37355-2414
Practice Address - Country:US
Practice Address - Phone:931-728-5522
Practice Address - Fax:931-728-2247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-11
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0604207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4039106OtherBCBS TN
TN4039106OtherBCBS TN
TN3306758Medicare PIN
TNB04893Medicare UPIN