Organization
PEDIATRICS & FAMILY MEDICINE OF BUENA VISTA , LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BILAL KHODR M.D. (MEDICAL DIRECTOR)
(352) 213-1243
Entity
Organization
Contact information
Practice address
10552 NW 13TH AVE, GAINESVILLE, FL 32606-8088
(678) 570-5063
Mailing address
519 BUENA VISTA ST, LAKELAND, FL 33805-4504
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
ME0072652
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
252009500
—
FL
Enumeration date
09/20/2013
Last updated
09/20/2013
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