MEDICARE: DR. MARILIZ BORBON BUMGARNER 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
1	208000000X	Pediatrics Physician	91688	FL
2	208000000X	Pediatrics Physician	ME-91688	FL
3	208000000X	Pediatrics Physician	ME91688	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	52180	OTHER	FL	BCBSH
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	7723670	OTHER	FL	AETNA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558366195
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARILIZ BORBON BUMGARNER M.D.

Provider Business Mailing Address
First Line	:	5150 CURRY FORD RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812-8744
Country	:	US
Telephone Number	:	239-600-9389
Fax Number	:	407-286-4739

Provider Business Practice Location Address
First Line	:	5150 CURRY FORD RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32812-8744
Country	:	US
Telephone Number	:	407-286-3653
Fax Number	:	407-286-4739

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	06/12/2024

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Directions to “ DR. MARILIZ BORBON BUMGARNER M.D.” Practice Location

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