Provider Demographics
NPI:1386751907
Name:FLORIDA DEPARTMENT OF HEALTH
Entity type:Organization
Organization Name:FLORIDA DEPARTMENT OF HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MURRAY
Authorized Official - Middle Name:F
Authorized Official - Last Name:DWECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-454-7148
Mailing Address - Street 1:2565 JUDGE FRAN JAMIESON WAY
Mailing Address - Street 2:
Mailing Address - City:VIERA
Mailing Address - State:FL
Mailing Address - Zip Code:32940-5998
Mailing Address - Country:US
Mailing Address - Phone:321-454-7148
Mailing Address - Fax:321-449-5015
Practice Address - Street 1:2555 JUDGE FRAN JAMIESON WAY
Practice Address - Street 2:
Practice Address - City:VIERA
Practice Address - State:FL
Practice Address - Zip Code:32940-5998
Practice Address - Country:US
Practice Address - Phone:321-639-5800
Practice Address - Fax:321-449-5015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2021-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL251K00000X
261QM1102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
No261QM1102XAmbulatory Health Care FacilitiesClinic/CenterMilitary Outpatient Operational (Transportable) Component
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL051925102Medicaid
051925192OtherMEDIPASS
051925193OtherMEDIPASS
FL051925101Medicaid
FL051925100Medicaid
051925191OtherMEDIPASS
FL051925102Medicaid
FL051925100Medicaid