Healthcare Provider Details

I. General information

NPI: 1013474063
Provider Name (Legal Business Name): SURGEONS OF CENTRAL FLORIDA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2019
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 JAY BEE AVENUE
DAVENPORT FL
33897
US

IV. Provider business mailing address

755 JAY BEE AVENUE
DAVENPORT FL
33897
US

V. Phone/Fax

Practice location:
  • Phone: 863-286-0607
  • Fax:
Mailing address:
  • Phone: 863-286-0607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: RUSSELL THEODORE BROWN
Title or Position: OWNER
Credential: MD
Phone: 863-276-0607