Healthcare Provider Details

I. General information

NPI: 1134426844
Provider Name (Legal Business Name): RIVER OF LIFE OSTEOPATHIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2011
Last Update Date: 02/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2705 MAGUIRE RD
OCOEE FL
34761-4797
US

IV. Provider business mailing address

2705 MAGUIRE RD
OCOEE FL
34761-4797
US

V. Phone/Fax

Practice location:
  • Phone: 407-574-2880
  • Fax: 407-403-5612
Mailing address:
  • Phone: 407-574-2880
  • Fax: 407-403-5612

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS9605
License Number StateFL

VIII. Authorized Official

Name: DR. RONALD WILLIAM TAYLOR JR.
Title or Position: DIRECTOR OF OPERATIONS
Credential: D.O.
Phone: 407-739-6914