Healthcare Provider Details

I. General information

NPI: 1275586802
Provider Name (Legal Business Name): INFECTIOUS DISEASE ASSOCIATES OF GREATER ORLANDO PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S ORLANDO AVE 205
WINTER PARK FL
32789-5543
US

IV. Provider business mailing address

1400 S ORLANDO AVE 205
WINTER PARK FL
32789-5543
US

V. Phone/Fax

Practice location:
  • Phone: 407-629-9400
  • Fax: 407-629-0017
Mailing address:
  • Phone: 407-629-9400
  • Fax: 407-629-0017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number State

VIII. Authorized Official

Name: VINCENT M SPOTO
Title or Position: PRESIDENT
Credential: M.D.
Phone: 407-629-9400