Healthcare Provider Details

I. General information

NPI: 1487313318
Provider Name (Legal Business Name): VMD PRIMARY PROVIDERS CENTRAL FLORIDA PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 01/14/2025
Certification Date: 01/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8951 HUDSON AVE
HUDSON FL
34667-8030
US

IV. Provider business mailing address

4650 WESTWAY PARK BLVD
HOUSTON TX
77041-2007
US

V. Phone/Fax

Practice location:
  • Phone: 407-798-8800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: REBECCA RAGER
Title or Position: DIRECTOR REVENUE CYCLE
Credential:
Phone: 844-969-0686