Organization
TUI FAMILY MEDICINE PL
Active
Organization
TUI FAMILY MEDICINE PL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANUNPORN SRISAWAT MD (MANAGING MEMBER)
(386) 304-2990
Entity
Organization
Contact information
Practice address
4554 S CLYDE MORRIS BLVD, SUITE 2, PORT ORANGE, FL 32129-5403
(386) 304-2990
Mailing address
PO BOX 290035, PORT ORANGE, FL 32129-0035
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
ME 95967
FL
Other
Enumeration date
01/27/2011
Last updated
10/12/2011
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