Organization
SANFORD PEDIATRIC ASSOCIATES PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN EDWARD TERWILLEGER M.D. (PRESIDENT)
(386) 851-0644
Entity
Organization
Contact information
Practice address
775 HARLEY STRICKLAND BLVD, SUITE 101, ORANGE CITY, FL 32763-7963
(386) 851-0644
(386) 851-0664
Mailing address
775 HARLEY STRICKLAND BLVD, SUITE 101, ORANGE CITY, FL 32763-7963
(386) 851-0644
(386) 851-0664
Taxonomy
Speciality
Code
Description
License number
State
2080A0000X
Pediatric Adolescent Medicine Physician
Primary
ME0045959
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
044243700
—
FL
Enumeration date
11/04/2015
Last updated
11/04/2015
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