Healthcare Provider Details

I. General information

NPI: 1619006681
Provider Name (Legal Business Name): BRIDGET FEY KOONTZ M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 N ORANGE AVE STE 182
ORLANDO FL
32804-4675
US

IV. Provider business mailing address

PO BOX 271647
SALT LAKE CITY UT
84127-1647
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-2030
  • Fax: 407-303-2042
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number200700324
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License NumberME168380
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: