Healthcare Provider Details

I. General information

NPI: 1306341631
Provider Name (Legal Business Name): ERIC LONGHUA WU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 08/22/2024
Certification Date: 08/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 W COLONIAL DR STE 390
OCOEE FL
34761-3433
US

IV. Provider business mailing address

10000 W COLONIAL DR STE 390
OCOEE FL
34761-3433
US

V. Phone/Fax

Practice location:
  • Phone: 407-648-5384
  • Fax: 321-843-6975
Mailing address:
  • Phone: 407-648-5384
  • Fax: 321-843-6975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD480803
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberME169684
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: