Organization
DR BEHAL'S FAMILY PRACTICE CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERENCE D' VAZ (MANAGER)
(863) 232-5062
Entity
Organization
Contact information
Practice address
1138 CARLTON AVE, LAKE WALES, FL 33853-4305
(863) 678-9900
(863) 678-9278
Mailing address
1138 CARLTON AVE, LAKE WALES, FL 33853-4305
(863) 678-9900
(863) 678-9278
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
ME91856
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01501
BCBS OF FL
FL
05
—
271785900
—
FL
Enumeration date
05/23/2008
Last updated
05/23/2008
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