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General NPI Number Information
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NPI Number | 1013214261
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Entity Type | Organization
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Legal Business Name | G BROCK MAGRUDER JR MD PA
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Dates
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Enumeration Date | 02/24/2011
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Last Update Date | 01/13/2012
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Provider Practice Location Address
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Address Line | 120 E PAR ST SUITE 2000
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City | ORLANDO
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State | FL
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Zip | 32804-3943
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Country | US
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Telephone | 407-843-5665
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Fax | 407-872-7939
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Provider Business Mailing Address
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Address Line | 120 E PAR ST SUITE 2000
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City | ORLANDO
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State | FL
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Zip | 32804-3943
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Country | US
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Telephone | 407-843-5665
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Fax | 407-872-7939
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. GEORGE B. MAGRUDER II
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Credential | M.D.
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Telephone | 407-843-5665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | ME56293
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License Number State | FL
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