Healthcare Provider Details

I. General information

NPI: 1760317978
Provider Name (Legal Business Name): ORLANDO ORTHOPAEDIC CENTER MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 W CRYSTAL LAKE ST STE 200
ORLANDO FL
32806-4476
US

IV. Provider business mailing address

25 W CRYSTAL LAKE ST STE 200
ORLANDO FL
32806-4476
US

V. Phone/Fax

Practice location:
  • Phone: 407-418-0570
  • Fax: 407-254-2557
Mailing address:
  • Phone: 407-418-0570
  • Fax: 407-254-2557

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: DYLAN FERSON
Title or Position: DIRECTOR OF BUSINESS DEVELOPMENT
Credential:
Phone: 407-418-0570