Healthcare Provider Details

I. General information

NPI: 1215090691
Provider Name (Legal Business Name): CENTER FOR REPRODUCTIVE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/18/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 PINEHURST AVE
ORLANDO FL
32804-4049
US

IV. Provider business mailing address

3435 PINEHURST AVE
ORLANDO FL
32804-4049
US

V. Phone/Fax

Practice location:
  • Phone: 407-740-0909
  • Fax: 407-740-5727
Mailing address:
  • Phone: 407-740-0909
  • Fax: 407-740-5727

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VE0102X
TaxonomyReproductive Endocrinology Physician
License Number
License Number State

VIII. Authorized Official

Name: RANDALL LOY
Title or Position: SECRETARY-TREASURER
Credential: M.D.
Phone: 407-740-0909