Provider Demographics
NPI:1578751145
Name:FAMILY PRATICE OF SUNTREE AND VIERA, P.A.
Entity Type:Organization
Organization Name:FAMILY PRATICE OF SUNTREE AND VIERA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:GIRARD
Authorized Official - Last Name:DITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-253-3944
Mailing Address - Street 1:2 SUNTREE PL
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7689
Mailing Address - Country:US
Mailing Address - Phone:321-253-3944
Mailing Address - Fax:321-253-4990
Practice Address - Street 1:2 SUNTREE PL
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7689
Practice Address - Country:US
Practice Address - Phone:321-253-3944
Practice Address - Fax:321-253-4990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME79520207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2822OtherMEDICARE PTAN