Healthcare Provider Details

I. General information

NPI: 1578662276
Provider Name (Legal Business Name): GENE LAVERE KRISHINGNER JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 11/19/2021
Certification Date: 11/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ROLLINS ST
ORLANDO FL
32803-1248
US

IV. Provider business mailing address

601 E ROLLINS ST
ORLANDO FL
32803-1248
US

V. Phone/Fax

Practice location:
  • Phone: 407-975-0406
  • Fax: 407-975-0407
Mailing address:
  • Phone: 407-975-0406
  • Fax: 407-975-0407

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberME96570
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: