Organization
INTEGRATED MEDICAL GROUP EASTERN REGION INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. AMANDO OBA SILVA JR. (PRESIDENT)
(224) 558-9705
Entity
Organization
Contact information
Practice address
3230 S BUFFALO DR, SUITE 105, LAS VEGAS, NV 89117-2505
(224) 558-9705
(702) 990-7371
Mailing address
9957 MOORINGS DR, SUITE 204, JACKSONVILLE, FL 32257-2412
(224) 558-9705
(702) 990-7371
Taxonomy
Speciality
Code
Description
License number
State
305R00000X
Preferred Provider Organization
P13000057299
FL
363L00000X
Nurse Practitioner
Primary
P13000057299
FL
Other
Enumeration date
08/12/2013
Last updated
08/12/2013
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