Organization
FAMILY CARE ON EUSTIS SQUARE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. KEITH R HESTER PA-C (OWNER)
(352) 357-4629
Entity
Organization
Contact information
Practice address
1 W PARK AVE, EUSTIS, FL 32726-2947
(352) 357-4629
(352) 357-9367
Mailing address
1 W PARK AVE, EUSTIS, FL 32726-2947
(352) 357-4629
(352) 357-9367
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA2446
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
259149900
—
FL
01
—
K0951
MEDICARE GROUP PTAN
FL
Enumeration date
09/01/2006
Last updated
07/23/2009
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