Organization
COASTAL FAMILY PRACTICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PAM LACEY (PRACTICE MANAGER)
(386) 761-6044
Entity
Organization
Contact information
Practice address
1404 S RIDGEWOOD AVE, EDGEWATER, FL 32132-2720
(386) 426-8166
(386) 426-6399
Mailing address
1404 S RIDGEWOOD AVE, EDGEWATER, FL 32132-2720
(386) 426-8166
(386) 426-6399
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
L800015935
FL
Other
Enumeration date
07/19/2006
Last updated
11/09/2009
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