Organization
SEBASTIAN HMA PHYSICIAN MANAGEMENT LLC
Active
Other names
North County Medical Laboratory
Organization subpart
No
Provider details
NPI number
Authorized official
DAVID DEPUTRON D.O. (PHYSICIAN)
(772) 581-6900
Entity
Organization
Contact information
Practice address
13850 US HIGHWAY 1, SEBASTIAN, FL 32958-3231
(772) 581-3366
(772) 581-3390
Mailing address
13850 US HIGHWAY 1, SEBASTIAN, FL 32958-3231
(772) 581-3366
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
800017216
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
593733467001
TRICARE
FL
01
—
690009384
RR MEDICARE
FL
01
—
L9231
BLUE CROSS BLUE SHIELD
FL
Enumeration date
05/04/2006
Last updated
01/19/2010
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