SOUTHEASTERN CENTER FOR INFECTIOUS DISEASES PA
Medical Practice at Miccosukee Rd, Tallahassee, FL

License number
Florida ME91513
Category
Medical Practice
Type
Specialist
Owner
Name: DR. PHILBERT J FORD M.D.
Title: PHYSICIAN
Phone: (850) 942-2299
Address
Address
2009 Miccosukee Rd, Tallahassee, FL 32308
National Provider ID: 1982747838
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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SOUTHEASTERN CENTER FOR INFECTIOUS DISEASES PA

Tallahassee, FL

Status:
Inactive
Inactive reason:
NAME CHANGE AMENDMENT
Registration:
Aug 22, 2006
Inactive since:
Oct 10, 2011
Addresses:
2009 Miccosukee Rd, Tallahassee, FL 32308 (Physical)
1213 Tmh Ct, Tallahassee, FL 32308
3319 Dry Crk Dr, Tallahassee, FL 32309
State ID:
P06000110062
Business type:
Florida Profit Corporation
President, Treasurer, Secretary, Director:
Philbert J Ford (President, Treasurer, Secretary, Director), 2009 Miccosukee Rd, Tallahassee, FL 32308 (Physical)
Agent:
Philbert Ford,2009 Miccosukee Rd, Tallahassee, FL 32308 (Physical)
EIN:
20-5417408

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