Healthcare Provider Details

I. General information

NPI: 1568415115
Provider Name (Legal Business Name): CHILDREN'S SURGICAL ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1814 LUCERNE TER SUITE A
ORLANDO FL
32806-2949
US

IV. Provider business mailing address

1814 LUCERNE TER SUITE A
ORLANDO FL
32806-2949
US

V. Phone/Fax

Practice location:
  • Phone: 407-540-1000
  • Fax: 407-540-1011
Mailing address:
  • Phone: 407-540-1000
  • Fax: 407-540-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0120X
TaxonomyPediatric Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ROSS MORGAN
Title or Position: PRESIDENT
Credential: MD
Phone: 407-540-1000