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NPI Code Detail

MEDICARE: MR. EPHRAIN ENRIQUE CORONADO M.D.

MEDICARE: MR. EPHRAIN ENRIQUE CORONADO M.D.
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
12085R0202XDiagnostic Radiology PhysicianME 65229FL
22085R0202XDiagnostic Radiology PhysicianME65229FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1417943242
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. EPHRAIN ENRIQUE CORONADO M.D.
Provider Business Mailing Address
First Line : 1150 S. SEMORAN BLVD
Second Line : SUITE C
City : ORLANDO
State : FL
Zip : 32807-1424
Country : US
Telephone Number : 407-482-5253
Fax Number : 407-482-5254
Provider Business Practice Location Address
First Line : 1150 S. SEMORAN BLVD
Second Line : SUITE D
City : ORLANDO
State : FL
Zip : 32807-1424
Country : US
Telephone Number : 407-482-5253
Fax Number : 407-482-5254
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/27/2005
Last Update Date : 07/16/2014

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