Organization Name: | NAVARRE FAMILY HEALTH PA |
NPI Number: | 1174761670 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JERRY D LEVENTHAL (M.D.) |
Mailing Address: | 1929 Ortega Street Navarre |
State: | FL US |
Postal Code: | 325664111 |
Phone Number: | 8509368048 |
Fax Number: | 8509368049 |
NPI Enumeration Date: | 01/22/2009 |
NPI Last Update Date: | 01/03/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QP2300X |
License Number: | ME69470 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | FL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Primary Care |
Taxonomy Definition: |