Healthcare Provider Details

I. General information

NPI: 1497785018
Provider Name (Legal Business Name): RUBEN TELAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 W COLONIAL DR
OCOEE FL
34761-3498
US

IV. Provider business mailing address

291 SOUTHHALL LN SUITE 201
MAITLAND FL
32751-7274
US

V. Phone/Fax

Practice location:
  • Phone: 407-667-0444
  • Fax: 407-667-4338
Mailing address:
  • Phone: 407-667-0444
  • Fax: 407-667-4338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME15519
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME15519
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: