Provider Demographics
NPI:1679664098
Name:ALL FAMILY CLINIC OF DAYTONA BEACH, INC
Entity Type:Organization
Organization Name:ALL FAMILY CLINIC OF DAYTONA BEACH, INC
Other - Org Name:FLORIDA MEDICAL ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:SEVERIANO
Authorized Official - Last Name:ALVAREZ, JR.
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-248-0107
Mailing Address - Street 1:1040 MASON AVENUE
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32117
Mailing Address - Country:US
Mailing Address - Phone:386-248-0107
Mailing Address - Fax:386-248-0109
Practice Address - Street 1:1040 MASON AVENUE
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32117
Practice Address - Country:US
Practice Address - Phone:386-248-0107
Practice Address - Fax:386-248-0109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME31437174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD57293Medicare UPIN
FL62112Medicare ID - Type Unspecified