Provider Demographics
NPI:1427239888
Name:FAMILY PRACTICE OF WEST VOLUSIA, P.A.
Entity type:Organization
Organization Name:FAMILY PRACTICE OF WEST VOLUSIA, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:G
Authorized Official - Last Name:RANKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:386-740-7080
Mailing Address - Street 1:999 W PLYMOUTH AVE
Mailing Address - Street 2:
Mailing Address - City:DELAND
Mailing Address - State:FL
Mailing Address - Zip Code:32720-3134
Mailing Address - Country:US
Mailing Address - Phone:386-740-7080
Mailing Address - Fax:386-734-0821
Practice Address - Street 1:999 W PLYMOUTH AVE
Practice Address - Street 2:
Practice Address - City:DELAND
Practice Address - State:FL
Practice Address - Zip Code:32720-3134
Practice Address - Country:US
Practice Address - Phone:386-740-7080
Practice Address - Fax:386-734-0821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2019-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS6029207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL77931Medicare UPIN