# A PREMIER MEDICAL RESEARCH OF FLORIDA L.L.C

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1043758782
- **Authorized official:** DR. GEORGE TATAW BESONG M.D. (PRESIDENT & CEO)
- **Authorized official phone:** (386) 747-9771

## Contact information

- **Practice address:** 2728 ENTERPRISE RD STE 200, ORANGE CITY, FL 32763-8276
- **Practice address phone:** (386) 747-9771
- **Mailing address:** 2111 HONTOON RD, DELAND, FL 32720-4308
- **Mailing address phone:** (386) 747-9771

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | — | NULL | — |
| 207L00000X | Anesthesiology Physician | — | — | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | ME074829 | FL | — |
| 207Q00000X | Family Medicine Physician | — | NULL | Yes |
| 207Q00000X | Family Medicine Physician | — | — | Yes |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 207V00000X | Obstetrics & Gynecology Physician | ME92729 | FL | — |

## Other

- **Enumeration date:** 02/01/2017
- **Last updated:** 02/01/2017