PORT ORANGE INTERNISTS PA
Marriage and Family Therapists at Turtle Creek Dr, Daytona Beach, FL

License number
Florida ME00050810
Category
Osteopathic Medicine
Type
Family Medicine
Owner
Name: SOUHEIL MOUSSLY MD
Title: OWNER
Phone: (386) 756-4400
Address
Address
3890 Turtle Creek Dr, Daytona Beach, FL 32127
National Provider ID: 1689861205
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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PORT ORANGE INTERNISTS, PA

3890 Turtle Crk Dr SUITE C, Port Orange, FL 32129

Status:
Inactive
Industry:
Medical Doctor's Office
Inactive reason:
NAME CHANGE AMENDMENT
Registration:
Feb 2, 1995
Inactive since:
Dec 15, 2004
Phone:
(386) 756-4400 (Phone)
State ID:
P95000009128
Business type:
Florida Profit Corporation
Chairman, Secretarys:
Souheil M.d. Moussly, 3890 Turtle Crk Dr SUITE C, Port Orange, FL 32129 (Physical),Souheil Moussly (President, Director, Secretary, Chairman), 3890 Turtle Crk Dr, Port Orange, FL 32129 (Physical),Henri H. Nammour Chairman, Secretary, inactive
Agent:
Moussly, Souheil, Dr,3890 Turtle Crk Dr SUITE C, Port Orange, FL 32129 (Physical)
EIN:
59-3292082

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