Provider Demographics
NPI:1801940945
Name:FAMILY MEDICINE CLINICS OF SOUTH FLORIDA PA
Entity type:Organization
Organization Name:FAMILY MEDICINE CLINICS OF SOUTH FLORIDA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:WARE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-745-7999
Mailing Address - Street 1:717 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:DUNEDIN
Mailing Address - State:FL
Mailing Address - Zip Code:34698-6912
Mailing Address - Country:US
Mailing Address - Phone:954-745-7999
Mailing Address - Fax:954-337-3199
Practice Address - Street 1:717 BROADWAY
Practice Address - Street 2:
Practice Address - City:DUNEDIN
Practice Address - State:FL
Practice Address - Zip Code:34698-6912
Practice Address - Country:US
Practice Address - Phone:954-745-7999
Practice Address - Fax:954-337-3199
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84821207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty