Organization · NPI-2

Advanced Family Medicine Clinic INC

Family Medicine · Crestview, FL

NPI number1184805830
StatusActive
Last updated in NPPESApr 17, 2020

Details

NPI
1184805830
Entity type
Organization (NPI-2)
Legal business name
Advanced Family Medicine Clinic INC
Organization subpart
No
Enumeration date
Nov 23, 2007
Certification date
Apr 17, 2020
Last updated
Apr 17, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
207Q00000X Family MedicineME89643FLYes

Practice location

327 Medcrest Drive
Unit A
Crestview, FL 32536

Phone 850-423-0761 · Fax 855-793-3568

Mailing address

327 Medcrest Drive
Unit A
Crestview, FL 32536

Phone 850-423-0761 · Fax 855-793-3568

Authorized official

Kate R Lops
Owner/Physician
8504230761

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