Healthcare Provider Details

I. General information

NPI: 1013212067
Provider Name (Legal Business Name): RHEUMATOLOGY ASSOCIATES OF CENTRAL FL.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/24/2011
Last Update Date: 01/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3160 SOUTHGATE COMMERCE BLVD BLDG SUITE30
ORLANDO FL
32806-8549
US

IV. Provider business mailing address

3160 SOUTHGATE COMMERCE BLVD BLDG SUITE30
ORLANDO FL
32806-8549
US

V. Phone/Fax

Practice location:
  • Phone: 407-859-4540
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA9101207
License Number StateFL

VIII. Authorized Official

Name: PAMELA FREEMAN
Title or Position: M.D.
Credential:
Phone: 407-859-4540