Healthcare Provider Details

I. General information

NPI: 1841663010
Provider Name (Legal Business Name): OBT FAMILY MEDICAL CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2015
Last Update Date: 12/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9480 S ORANGE BLOSSOM TRL
ORLANDO FL
32837-8321
US

IV. Provider business mailing address

10450 TURKEY LAKE RD UNIT 691483
ORLANDO FL
32869-7501
US

V. Phone/Fax

Practice location:
  • Phone: 407-230-2108
  • Fax:
Mailing address:
  • Phone: 407-230-2108
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CARLESA PIERRE
Title or Position: OWNER
Credential:
Phone: 407-230-2108