Ellenton Family Practice Direct PLLC
Family Medicine in Ellenton, FL. Organization (NPI-2).
NPI number1124471503
StatusActive
Last updated in NPPESMar 7, 2023
Details
- NPI
- 1124471503
- Entity type
- Organization (NPI-2)
- Legal business name
- Ellenton Family Practice Direct PLLC
- Organization subpart
- No
- Enumeration date
- Jul 20, 2016
- Last updated
- Mar 7, 2023
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | PA9102767 | FL | Yes |
Practice location
907 25th Dr EEllenton, FL 34222-2053
Phone 941-321-8299
Mailing address
907 25th Dr EEllenton, FL 34222-2053
Phone 941-417-7386
Authorized official
David Allan Hervig
Office Manage And Partner
9417305326
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