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General NPI Number Information
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NPI Number | 1104864826
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Entity Type | Organization
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Legal Business Name | SAND LAKE MEDICAL ASSOCIATES, P.A.
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Dates
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Enumeration Date | 06/03/2006
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Last Update Date | 07/30/2009
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Provider Practice Location Address
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Address Line | 6200 METROWEST BLVD SUITE 106
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City | ORLANDO
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State | FL
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Zip | 32835-7636
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Country | US
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Telephone | 407-345-1551
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Fax | 407-345-4893
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Provider Business Mailing Address
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Address Line | 6200 METROWEST BLVD SUITE 106
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City | ORLANDO
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State | FL
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Zip | 32835-7636
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Country | US
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Telephone | 407-345-1551
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Fax | 407-345-4893
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | DR. VICTOR HUNT HARDING
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Credential | M.D.
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Telephone | 407-345-1551
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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 |
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License Number State | FL
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