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General NPI Number Information
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NPI Number | 1114901816
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Entity Type | Organization
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Legal Business Name | WINTER PARK FAMILY HEALTH CENTER INC
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Dates
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Enumeration Date | 12/06/2005
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Last Update Date | 06/09/2015
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Provider Practice Location Address
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Address Line | 2304 ALOMA AVE STE 100
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City | WINTER PARK
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State | FL
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Zip | 32792-3330
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Country | US
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Telephone | 407-679-9222
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Fax | 407-679-9061
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Provider Business Mailing Address
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Address Line | 2304 ALOMA AVE 100
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City | WINTER PARK
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State | FL
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Zip | 32792-3330
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Country | US
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Telephone | 407-679-9222
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Fax | 407-679-9061
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Authorized Official
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Title or Position | PRESIDENT
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Name | RONALD LORIN SHAW
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Credential | MD
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Telephone | 407-679-9222
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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 |
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