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Organization
PRIMARY CARE CENTER OF PORT ORANGE
Active
Organization
PRIMARY CARE CENTER OF PORT ORANGE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MICHELLE L JACKSON (OFFICE MANAGER)
(386) 761-0050
Entity
Organization
Contact information
Practice address
4770 S RIDGEWOOD AVE, SUITE 1, PORT ORANGE, FL 32127-4544
(386) 761-0050
(386) 761-1167
Mailing address
4770 S RIDGEWOOD AVE, SUITE 1, PORT ORANGE, FL 32127-4544
(386) 761-0050
(386) 761-1167
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME0028054
FL
Other
Enumeration date
01/02/2008
Last updated
03/29/2011
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