| Vicencio Antonio III | |
|
21 Hospital Dr Suite 230 Palm Coast FL 32164-2452 | |
| (386) 586-3466 | |
| (386) 586-3467 |
| Full Name | Vicencio Antonio III |
|---|---|
| Speciality | Family Medicine |
| Location | 21 Hospital Dr, Palm Coast, Florida |
| Authorized Official Name and Position | Antonio Sison Vicencio (SOLE PROPRIETOR) |
| Authorized Official Contact | 3865863466 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vicencio Antonio III Po Box 354339 Palm Coast FL 32135-4339 Ph: (386) 586-3466 | Vicencio Antonio III 21 Hospital Dr Suite 230 Palm Coast FL 32164-2452 Ph: (386) 586-3466 |
| NPI Number | 1912177577 |
|---|---|
| Provider Enumeration Date | 03/10/2008 |
| Last Update Date | 09/10/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912177577 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | () | Primary |
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