Healthcare Provider Details

I. General information

NPI: 1770590804
Provider Name (Legal Business Name): FLORIDA VASCULAR CONSULTANTS PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S MAITLAND AVE
MAITLAND FL
32751-5619
US

IV. Provider business mailing address

400 S MAITLAND AVE
MAITLAND FL
32751-5619
US

V. Phone/Fax

Practice location:
  • Phone: 407-539-2100
  • Fax: 407-539-1472
Mailing address:
  • Phone: 407-539-2100
  • Fax: 407-539-1472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: DR. G. KENDRIX ADCOCK
Title or Position: PRESIDENT / SURGEON
Credential: M.D.
Phone: 407-539-2100