Healthcare Provider Details

I. General information

NPI: 1235276056
Provider Name (Legal Business Name): ARTHUR JOSEPH DEBAISE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 01/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE SUITE 411
ORLANDO FL
32803-4644
US

IV. Provider business mailing address

2501 N ORANGE AVE SUITE 411
ORLANDO FL
32803-4644
US

V. Phone/Fax

Practice location:
  • Phone: 407-478-0517
  • Fax: 407-646-7370
Mailing address:
  • Phone: 407-478-0517
  • Fax: 407-646-7370

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberME 57231
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: