Provider Demographics
NPI:1962709725
Name:DAVID L FROMANG MD PA
Entity type:Organization
Organization Name:DAVID L FROMANG MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:FROMANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD PA
Authorized Official - Phone:772-466-2700
Mailing Address - Street 1:1912 NEBRASKA AVE
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4820
Mailing Address - Country:US
Mailing Address - Phone:772-466-2700
Mailing Address - Fax:772-465-1230
Practice Address - Street 1:1912 NEBRASKA AVE
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4820
Practice Address - Country:US
Practice Address - Phone:772-466-2700
Practice Address - Fax:772-465-1230
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-14
Last Update Date:2011-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD57633Medicare UPIN