Provider Demographics
NPI:1396037297
Name:RELIANT FAMILY PRACTICE PA
Entity Type:Organization
Organization Name:RELIANT FAMILY PRACTICE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHABERT
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-514-6452
Mailing Address - Street 1:4408 NW 36TH AVE
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32606-7215
Mailing Address - Country:US
Mailing Address - Phone:352-514-6452
Mailing Address - Fax:321-600-2007
Practice Address - Street 1:4408 NW 36TH AVE
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-7215
Practice Address - Country:US
Practice Address - Phone:352-514-6452
Practice Address - Fax:321-600-2007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-10
Last Update Date:2011-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9641305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization