Healthcare Provider Details

I. General information

NPI: 1316996325
Provider Name (Legal Business Name): DIABETES & ENDOCRINE CENTER OF ORLANDO, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 11/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3113 LAWTON RD SUITE 100
ORLANDO FL
32803-3531
US

IV. Provider business mailing address

3113 LAWTON RD SUITE 100
ORLANDO FL
32803-3531
US

V. Phone/Fax

Practice location:
  • Phone: 407-894-3241
  • Fax: 407-896-9863
Mailing address:
  • Phone: 407-894-3241
  • Fax: 407-896-9863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberME0043196
License Number StateFL

VIII. Authorized Official

Name: DR. ROBERT CONSTANT
Title or Position: OWNER/PRESIDENT
Credential: M.D.
Phone: 407-894-3241