MEDICARE: HOME PHYSICIANS GROUP P.A.

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	207QA0505X	Adult Medicine Physician	OS7691	FL

General Provider Information

NPI Number	:	1700273000
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOME PHYSICIANS GROUP P.A.

Provider Business Mailing Address
First Line	:	1834 N ALAFAYA TRL
Second Line	:	SUITE A
City	:	ORLANDO
State	:	FL
Zip	:	32826-4743
Country	:	US
Telephone Number	:	321-235-0692
Fax Number	:	321-235-0694

Provider Business Practice Location Address
First Line	:	1834 N ALAFAYA TRL
Second Line	:	STE A
City	:	ORLANDO
State	:	FL
Zip	:	32826-4743
Country	:	US
Telephone Number	:	321-235-0694
Fax Number	:	321-235-0694

Authorized Official
Title or Position	:	CEO
Name	:	GABRIEL NURIEL
Credential	:	D.O.
Telephone Number	:	407-590-6399

Provider Enumeration Date	:	04/24/2015
Last Update Date	:	04/24/2015

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