Organization
DMSP LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
EUGENE WIGGINS (CREDENTIALING MANAGER)
(904) 955-0562
Entity
Organization
Contact information
Practice address
2020 HIGHWAY A1A STE 101, INDIAN HARBOUR BEACH, FL 32937-3581
(321) 777-4774
Mailing address
1678 MAEVE CIR, MELBOURNE, FL 32904-7348
Taxonomy
Speciality
Code
Description
License number
State
261QP1100X
Podiatric Clinic/Center
Primary
—
—
Other
Enumeration date
05/30/2019
Last updated
05/30/2019
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