Healthcare Provider Details

I. General information

NPI: 1629394267
Provider Name (Legal Business Name): YARON IVAN M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2010
Last Update Date: 10/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 E ROLLINS ST
ORLANDO FL
32803-1248
US

IV. Provider business mailing address

500 WINDERLEY PL
MAITLAND FL
32751-7247
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-9732
  • Fax:
Mailing address:
  • Phone: 407-875-0555
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0204X
TaxonomyPediatric Emergency Medicine (Pediatrics) Physician
License NumberME126861
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: