SANFORD PEDIATRIC ASSOCIATES PA
Medical Practice at Harley Strickland Blvd, Orange City, FL

License number
Florida ME0045959
Category
Medical Practice
Type
Adolescent Medicine
Owner
Name: DR. JOHN EDWARD TERWILLEGER M.D.
Title: PRESIDENT
Phone: (386) 851-0644
Address
Address
775 Harley Strickland Blvd SUITE 101, Orange City, FL 32763
National Provider ID: 1124491816
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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SANFORD PEDIATRIC ASSOCIATES, PA

775 Harley Strickland Blvd STE 101, Orange City, FL 32763

Status:
Inactive
Inactive reason:
NAME CHANGE AMENDMENT
Registration:
Jun 25, 1973
Inactive since:
Feb 19, 1996
State ID:
604444
Business type:
Florida Profit Corporation
President, Director:
John Em.d. Terwilleger (President, Director), 775 Harley Strickland Blvd, Orange City, FL 32763 (Physical)
Agent:
John Terwilleger,775 Harley Strickland Blvd, Orange City, FL 32763 (Physical)
EIN:
59-1465150

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