Organization
FAMILY PRACTICE CENTER OF SANFORD PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. LYNN H CLEARY (OFFICE MANAGER)
(407) 322-6341
Entity
Organization
Contact information
Practice address
712 W 25TH ST, SANFORD, FL 32771-4232
(407) 322-6341
Mailing address
712 W 25TH ST, SANFORD, FL 32771-4232
(407) 322-6341
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
99331
BCB GRP BILL PROVIDER NUM
FL
Enumeration date
03/23/2007
Last updated
08/22/2020
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