Organization · Type 2 NPI

State of Florida

Primary Care Clinic/Center · Port St. Joe, FL

NPI number 1104003995 Active

About NPI 1104003995

State of Florida's National Provider Identifier is 1104003995, issued on Jan 24, 2008. The primary taxonomy on file is Primary Care Clinic/Center (261QP2300X), and the practice location is in Port St. Joe, FL. The record was last updated on Apr 27, 2012.