| NPI | 1295920676 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN T CHACKO Managing Director 352-522-1101 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: FL ME74735) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: FL ME74735) |
| 207R00000X Internal Medicine (Licence: FL ME74735) | |
| Enumeration Date | 2007-09-10 |
| Last Update Date | 2008-12-20 |