Organization
COQUELET AND PUNGER FAMILY MEDICINE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DENISE S DINOCOLA (PRACTICE ADMINISTRATOR)
(772) 466-8884
Entity
Organization
Contact information
Practice address
4640 S 25TH ST, FORT PIERCE, FL 34981-5057
(772) 466-8832
Mailing address
4640 S 25TH ST, FORT PIERCE, FL 34981-5057
(772) 466-8832
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME68275
FL
207Q00000X
Family Medicine Physician
OS6690
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
23089
SOUTHCARE-COVENTRY HEALTH
FL
05
—
269585500
—
FL
01
—
74659
BCBS OF FL
FL
01
—
DD5441
RAILROAD MEDICARE
FL
Enumeration date
12/21/2006
Last updated
03/17/2009
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