Healthcare Provider Details
I. General information
NPI: 1053599696
Provider Name (Legal Business Name): CENTRAL FLORIDA UROLOGY SPECIALISTS
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 02/06/2008
Last Update Date: 05/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
12109 CR 103
OXFORD FL
34484-2967
US
IV. Provider business mailing address
12109 CR 103
OXFORD FL
34484-2967
US
V. Phone/Fax
- Phone: 352-391-6494
- Fax: 352-694-6498
- Phone: 352-391-6494
- Fax: 352-391-6498
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208800000X |
| Taxonomy | Urology Physician |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
HARVEY
CARL
TAUB
Title or Position: PRESIDENT
Credential: M.D.
Phone: 352-351-1313