Healthcare Provider Details

I. General information

NPI: 1215980354
Provider Name (Legal Business Name): FLORIDA PHYSICIANS MEDICAL GROUP, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

438 E VANN RD SUITE 200
GREENEVILLE TN
37743-7202
US

IV. Provider business mailing address

PO BOX 538600
ORLANDO FL
32853-8600
US

V. Phone/Fax

Practice location:
  • Phone: 423-278-1704
  • Fax: 423-278-1832
Mailing address:
  • Phone: 407-200-2700
  • Fax: 407-200-4904

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. BRYAN STILTZ
Title or Position: PRESIDENT
Credential:
Phone: 407-200-2700