Provider Demographics
NPI:1972696011
Name:YOU AND YOUR HEALTH FAMILY CARE INC
Entity Type:Organization
Organization Name:YOU AND YOUR HEALTH FAMILY CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PERTH
Authorized Official - Middle Name:AGUSTA
Authorized Official - Last Name:BLAKE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-508-5046
Mailing Address - Street 1:PO BOX 1245
Mailing Address - Street 2:
Mailing Address - City:TAVARES
Mailing Address - State:FL
Mailing Address - Zip Code:32778-1245
Mailing Address - Country:US
Mailing Address - Phone:352-508-5046
Mailing Address - Fax:352-508-5048
Practice Address - Street 1:1840 CLASSIQUE LN
Practice Address - Street 2:
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-5748
Practice Address - Country:US
Practice Address - Phone:352-508-5046
Practice Address - Fax:352-508-5048
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0069890207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31711YOtherMEDICARE ID
FL31711OtherBCBS