Dr Behal'S Family Practice Clinic

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

ME91856 Issued in FL

Legal business name

DR BEHAL'S FAMILY PRACTICE CLINIC

Practice address

1138 Carlton Ave
Lake Wales, FL 33853-4305

Phone

(863) 678-9900

Fax

(863) 678-9278

NPI assigned

May 23, 2008

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Terence D' Vaz

Title

Manager

Phone

(863) 232-5062

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1211500800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1211500800000",
    "number": "1801054036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1138 CARLTON AVE",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338534305",
            "telephone_number": "863-678-9900",
            "fax_number": "863-678-9278"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1138 CARLTON AVE",
            "city": "LAKE WALES",
            "state": "FL",
            "postal_code": "338534305",
            "telephone_number": "863-678-9900",
            "fax_number": "863-678-9278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR BEHAL'S FAMILY PRACTICE CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-23",
        "last_updated": "2008-05-23",
        "status": "A",
        "authorized_official_last_name": "D' VAZ",
        "authorized_official_first_name": "TERENCE",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "863-232-5062"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": "FL",
            "license": "ME91856",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "271785900",
            "state": "FL"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBS OF FL",
            "identifier": "01501",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Sentreila Collen Dinkens, RN
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• Silas Doku
• Sandra Collins Domanski, PT
• Aaron Rene Allick Douen, M.D.
• Dream Achievers Resource and Development Center Inc
• Dreamz to Reality LLC
• Valentina Ductan, CRANIAL PROSTHESIS S
• Fresenai Ararso Duguma, PHARMD
• Catherine Roberts Duncan, DVM

• Family Medicine Physician in Lake Wales, FL
• Providers in Lake Wales, FL by specialty
• Family Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 23, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.