# DR BEHAL'S FAMILY PRACTICE CLINIC

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

## Provider details

- **NPI number:** 1801054036
- **Authorized official:** TERENCE D' VAZ (MANAGER)
- **Authorized official phone:** (863) 232-5062

## Contact information

- **Practice address:** 1138 CARLTON AVE, LAKE WALES, FL 33853-4305
- **Practice address phone:** (863) 678-9900
- **Practice address fax:** (863) 678-9278
- **Mailing address:** 1138 CARLTON AVE, LAKE WALES, FL 33853-4305
- **Mailing address phone:** (863) 678-9900
- **Mailing address fax:** (863) 678-9278

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | ME91856 | FL | Yes |

## Other

- **Enumeration date:** 05/23/2008
- **Last updated:** 05/23/2008