Organization
HEATHROW OB GYN
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN JOHANNESSEN (VP OPERATIONS)
(386) 775-4448
Entity
Organization
Contact information
Practice address
942 SAXON BLVD, SUITE A, ORANGE CITY, FL 32763-8358
(386) 775-4448
(386) 775-4449
Mailing address
942 SAXON BLVD, SUITE A, ORANGE CITY, FL 32763-8358
(386) 775-4448
(386) 775-4449
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Enumeration date
03/06/2008
Last updated
03/06/2008
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