MEDICARE: SEMORAN PARK FAMILY PHYSICIANS, PA

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	ME82356	FL

General Provider Information

NPI Number	:	1477749778
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SEMORAN PARK FAMILY PHYSICIANS, PA

Provider Business Mailing Address
First Line	:	1277 N SEMORAN BLVD
Second Line	:	SUITE 104
City	:	ORLANDO
State	:	FL
Zip	:	32807-3569
Country	:	US
Telephone Number	:	407-447-7550
Fax Number	:	407-447-7551

Provider Business Practice Location Address
First Line	:	1277 N SEMORAN BLVD
Second Line	:	SUITE 104
City	:	ORLANDO
State	:	FL
Zip	:	32807-3569
Country	:	US
Telephone Number	:	407-447-7550
Fax Number	:	407-447-7551

Authorized Official
Title or Position	:	OWNER
Name	:	JENNIFER LYNN GOLDIN
Credential	:	M.D.
Telephone Number	:	407-447-7550

Provider Enumeration Date	:	09/20/2007
Last Update Date	:	09/20/2007

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