Organization
SPACE COAST FAMILY PRACTICE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS CHARLES BETKA MD (PRESIDENT)
(920) 544-5868
Entity
Organization
Contact information
Practice address
3067 WINDLAND DR, GREEN BAY, WI 54311-7574
(920) 544-5868
Mailing address
3067 WINDLAND DR, GREEN BAY, WI 54311-7574
(920) 544-5868
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
ME88311
FL
Other
Enumeration date
09/01/2006
Last updated
08/22/2020
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