Organization
DYNAMIC PRIMARY HEALTHCARE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOHN DISTEFANO (BUSINESS MANAGER)
(352) 317-3214
Entity
Organization
Contact information
Practice address
163 SW STONEGATE TER STE 109, LAKE CITY, FL 32024-3459
(330) 323-8976
Mailing address
924 SE LANTANA LOOP, LAKE CITY, FL 32025-6848
(330) 323-8976
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Enumeration date
02/24/2022
Last updated
03/18/2024
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