Provider Demographics
NPI:1437755345
Name:WEST FLORIDA MEDICAL ASSOCIATES, PA
Entity Type:Organization
Organization Name:WEST FLORIDA MEDICAL ASSOCIATES, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ULHAS
Authorized Official - Middle Name:T
Authorized Official - Last Name:DEVEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-464-0762
Mailing Address - Street 1:3920 N GRAYHAWK LOOP
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-8471
Mailing Address - Country:US
Mailing Address - Phone:352-464-0762
Mailing Address - Fax:
Practice Address - Street 1:41 N INGLIS AVE STE B
Practice Address - Street 2:
Practice Address - City:INGLIS
Practice Address - State:FL
Practice Address - Zip Code:34449-9463
Practice Address - Country:US
Practice Address - Phone:352-447-2122
Practice Address - Fax:352-465-7576
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WEST FLORIDA MEDICAL ASSOCIATES, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-12-07
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health