East Volusia Family Practice PA

NPI #1053384610 in Port Orange, Florida

Provider Information

NPI Number: 1053384610
Entity Type: Organization
Organization Name: East Volusia Family Practice PA
Primary Specialty: Family Medicine
Enumeration Date: Feb 13, 2006
Last Updated: Jul 9, 2008

Practice Location

Address: 3911 S NOVA RD
City: Port Orange
State: Florida
ZIP Code: 32127-4910
Phone: (386) 322-0811

Authorized Official

Name: DR. LANE E JENNINGS, M.D.
Title: PRESIDENT
Phone: (386) 322-0811

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Family Medicine	207Q00000X	Primary

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