Provider Demographics
NPI:1205484110
Name:NEOTERIC MEDICAL LLC
Entity type:Organization
Organization Name:NEOTERIC MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIO
Authorized Official - Middle Name:
Authorized Official - Last Name:BRUNO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:321-890-7395
Mailing Address - Street 1:407 WEKIVA SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32779-6201
Mailing Address - Country:US
Mailing Address - Phone:407-564-1440
Mailing Address - Fax:321-244-0619
Practice Address - Street 1:407 WEKIVA SPRINGS RD
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32779-6201
Practice Address - Country:US
Practice Address - Phone:407-564-1440
Practice Address - Fax:321-244-0619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-04
Last Update Date:2019-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty