Healthcare Provider Details

I. General information

NPI: 1497510978
Provider Name (Legal Business Name): FLORIDA RADIOLOGY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/14/2024
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 E DIXIE AVE
LEESBURG FL
34748-5925
US

IV. Provider business mailing address

1895 TYLER ST STE 207
HOLLYWOOD FL
33020-4828
US

V. Phone/Fax

Practice location:
  • Phone: 747-924-9005
  • Fax:
Mailing address:
  • Phone: 877-224-8003
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QR0200X
TaxonomyRadiology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: PATRICK SANTORE JR.
Title or Position: VICE PRESIDENT
Credential:
Phone: 813-924-1577