Healthcare Provider Details

I. General information

NPI: 1104964253
Provider Name (Legal Business Name): FELIPE COLLAZO-PAGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 03/02/2020
Certification Date: 03/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S ORANGE AVE
ORLANDO FL
32806-2134
US

IV. Provider business mailing address

8450 REYMONT ST
ORLANDO FL
32827-7430
US

V. Phone/Fax

Practice location:
  • Phone: 352-343-1341
  • Fax:
Mailing address:
  • Phone: 407-928-5766
  • Fax: 407-313-0731

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberME79942
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: