Healthcare Provider Details

I. General information

NPI: 1881784031
Provider Name (Legal Business Name): LAUREL OAKS FAMILY PRACTICE PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 MAGUIRE RD
OCOEE FL
34761
US

IV. Provider business mailing address

2711 MAGUIRE RD
OCOEE FL
34761
US

V. Phone/Fax

Practice location:
  • Phone: 407-877-1990
  • Fax: 407-877-1995
Mailing address:
  • Phone: 407-877-1990
  • Fax: 407-877-1995

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. JAMES B WILSON JR.
Title or Position: PRESIDENT
Credential: DO
Phone: 407-877-1990