Healthcare Provider Details

I. General information

NPI: 1265509962
Provider Name (Legal Business Name): FLORIDA RADIOLOGY ASSOCIATES PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 08/07/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2566 LEE RD
WINTER PARK FL
32789-1746
US

IV. Provider business mailing address

PO BOX 150505
ALTAMONTE SPRINGS FL
32715-0505
US

V. Phone/Fax

Practice location:
  • Phone: 407-303-1200
  • Fax: 407-303-1213
Mailing address:
  • Phone: 407-767-0433
  • Fax: 407-767-0608

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085U0001X
TaxonomyDiagnostic Ultrasound Physician
License Number
License Number State

VIII. Authorized Official

Name: CHARLES MAY
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 407-767-5306