10D2131445 CLIA NUMBER - DUNLAWTON FAMILY MEDICINE, PLC

Laboratory Demographics

CLIA Number: 10D2131445

Facility Name: DUNLAWTON FAMILY MEDICINE, PLC

Facility Address:
790 DUNLAWTON AVENUE STE D
PORT ORANGE, FL
ZIP 32127
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Facility Phone Number: 386 304-9556

Facility Type: Physician Office

Certificate Type: Waiver

NPI Number: 1629061767

Taxonomy: 261QP2300X - Clinic/Center

CLIA Record

Field Name	Field Value
CLIA Number	10D2131445
LAB Type	Physician Office
Facility Name	DUNLAWTON FAMILY MEDICINE, PLC
Street	790 DUNLAWTON AVENUE STE D
City	PORT ORANGE
State	FL
ZIP	32127
Phone	386 304-9556
CertificateType	4
CertificateEffectiveDate	5/30/2023
CertificateExpirationDate	5/29/2025
FacilityType	Waiver

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This page was last updated on: 4/23/2024