Provider Information for 1710246574
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FAMOUS ERWIN
Sex: Male
NPI: 1710246574
Last Updated: 2021-01-07
Certification Date: 2021-01-07
Certification Date: 2021-01-07
Details
| Name | Value | ||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| NPI | 1710246574 | ||||||||||||
| Enumeration Date | 2012-05-14 | ||||||||||||
| NPI Type | NPI-1 Individual | ||||||||||||
| Sole Proprietor | YES | ||||||||||||
| Status | Active | ||||||||||||
| Mailing Address | 3150 CARDINAL DR VERO BEACH, FL 32963-1931 United States Phone: 772-985-4941 | Fax: | ||||||||||||
| Primary Practice Address | 3150 CARDINAL DR VERO BEACH, FL 32963-1931 United States Phone: 772-985-4941 | Fax:772-365-2906 | ||||||||||||
| Secondary Practice Address(es) | 2814 S US HIGHWAY 1 | ||||||||||||
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