MEDICARE: FAMILY MEDICINE OF ORLANDO PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	OS10206	FL

General Provider Information

NPI Number	:	1417249830
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY MEDICINE OF ORLANDO PLLC

Provider Business Mailing Address
First Line	:	2295 S HIAWASSEE RD STE 210
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-8748
Country	:	US
Telephone Number	:	407-802-3233
Fax Number	:	407-233-4010

Provider Business Practice Location Address
First Line	:	2295 S HIAWASSEE RD STE 210
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-8748
Country	:	US
Telephone Number	:	407-802-3233
Fax Number	:	407-233-4010

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DANIEL RSA HAY
Credential	:	DO
Telephone Number	:	718-324-3611

Provider Enumeration Date	:	05/03/2011
Last Update Date	:	12/13/2022

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