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General NPI Number Information
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NPI Number | 1073622247
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Entity Type | Organization
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Legal Business Name | CENTRAL FLORIDA FAMILY MEDICAL GROUP
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1170 S SEMORAN BLVD SUITE A
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City | ORLANDO
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State | FL
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Zip | 32807-1458
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Country | US
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Telephone | 407-281-9105
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Fax | 407-281-9305
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Provider Business Mailing Address
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Address Line | 1170 S SEMORAN BLVD SUITE A
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City | ORLANDO
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State | FL
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Zip | 32807-1458
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Country | US
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Telephone | 407-281-9105
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Fax |
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Authorized Official
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Title or Position | C.F.O
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Name | IVAN REYES
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Credential |
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Telephone | 407-281-9105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State | FL
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