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General NPI Number Information
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NPI Number | 1023384484
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Entity Type | Organization
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Legal Business Name | CENTRAL FLORIDA OTOLARYNGOLOGY PLLC
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Dates
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Enumeration Date | 03/29/2012
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Last Update Date | 03/29/2012
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Provider Practice Location Address
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Address Line | 410 LIONEL WAY STE 202
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City | DAVENPORT
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State | FL
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Zip | 33837
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Country | US
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Telephone | 863-225-6522
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Fax | 863-582-9796
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Provider Business Mailing Address
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Address Line | 410 LIONEL WAY STE 202
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City | DAVENPORT
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State | FL
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Zip | 33837
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Country | US
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Telephone | 863-225-6522
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Fax | 863-582-9796
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Authorized Official
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Title or Position | OWNER
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Name | DR. MENACHEM M STUART
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Credential | MD
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Telephone | 863-225-6522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number |
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License Number State |
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