Organization
PORT ORANGE GYNECOLOGY LLC
Active
Other names
Port Orange Gynecology LLC
Organization subpart
No
Provider details
NPI number
Authorized official
PAULA M. FOUST M.D. (M.D. OWNER)
(386) 492-6929
Entity
Organization
Contact information
Practice address
900 N SWALLOWTAIL DR, ST 102B, PORT ORANGE, FL 32129-6102
(386) 492-6929
(386) 492-6930
Mailing address
PO BOX 12051, BELFAST, ME 04915-4011
(386) 492-6929
(386) 492-6930
Taxonomy
Speciality
Code
Description
License number
State
207VG0400X
Gynecology Physician
Primary
ME97528
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
277730400
—
FL
Enumeration date
07/01/2013
Last updated
10/09/2013
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