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General NPI Number Information
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NPI Number | 1275830960
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Entity Type | Organization
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Legal Business Name | CENTRAL FLORIDA EAR, NOSE AND THROAT SPECIALISTS, PA
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Dates
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Enumeration Date | 02/16/2011
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Last Update Date | 01/26/2012
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Provider Practice Location Address
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Address Line | 925 WILLISTON PARK PT 1001
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City | LAKE MARY
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State | FL
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Zip | 32746-2114
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Country | US
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Telephone | 407-804-8795
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Fax |
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Provider Business Mailing Address
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Address Line | 925 WILLISTON PARK PT 1001
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City | LAKE MARY
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State | FL
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Zip | 32746-2114
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Country | US
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Telephone | 407-804-8795
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MICHAEL BRANCH
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Credential | M.D.
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Telephone | 407-804-8795
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | ME66400
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License Number State | FL
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