Provider Demographics
NPI:1295783504
Name:TE ENOCH MD LLC
Entity type:Organization
Organization Name:TE ENOCH MD LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:TOMMY
Authorized Official - Middle Name:ERRICE
Authorized Official - Last Name:ENOCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-656-8944
Mailing Address - Street 1:1616 RIGGINS RD
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32308-5316
Mailing Address - Country:US
Mailing Address - Phone:850-656-8944
Mailing Address - Fax:850-878-1824
Practice Address - Street 1:1616 RIGGINS RD
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32308-5316
Practice Address - Country:US
Practice Address - Phone:850-656-8944
Practice Address - Fax:850-878-1824
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL22081261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL78078OtherBLUE CROSS BLUE SHIELD
FLQ0052Medicare PIN
FL78078OtherBLUE CROSS BLUE SHIELD