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General NPI Number Information
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NPI Number | 1003320730
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Entity Type | Organization
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Legal Business Name | AMS MEDICAL GROUP
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Dates
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Enumeration Date | 11/16/2017
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Last Update Date | 11/16/2017
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Provider Practice Location Address
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Address Line | 2258 E IRLO BRONSON MEMORIAL HWY
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City | KISSIMMEE
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State | FL
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Zip | 34744-4421
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Country | US
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Telephone | 407-750-8750
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Fax | 407-750-8752
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Provider Business Mailing Address
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Address Line | 2258 E IRLO BRONSON MEMORIAL HWY
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City | KISSIMMEE
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State | FL
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Zip | 34744-4421
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Country | US
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Telephone | 407-750-8750
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Fax | 407-750-8752
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Authorized Official
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Title or Position | OWNER/OFFICE MANAGER
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Name | MRS. NIDIA GOMEZ
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Credential |
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Telephone | 407-750-8750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | ME74515
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License Number State | FL
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