Healthcare Provider Details

I. General information

NPI: 1235619727
Provider Name (Legal Business Name): ORTHO FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/15/2018
Last Update Date: 03/04/2020
Certification Date: 03/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 BAYOU BLVD STE 107
PENSACOLA FL
32503-2543
US

IV. Provider business mailing address

PO BOX 978766
DALLAS TX
75397-8766
US

V. Phone/Fax

Practice location:
  • Phone: 850-492-7775
  • Fax:
Mailing address:
  • Phone: 561-300-1792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0801X
TaxonomyOrthopaedic Trauma Physician
License Number
License Number State

VIII. Authorized Official

Name: ADRIANA WEICHT
Title or Position: COO
Credential:
Phone: 561-300-1792