=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396792727
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAVID PRISCAL MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/30/2006
-----------------------------------------------------
Last Update Date | 12/07/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6336 W COLONIAL DR
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32818-7812
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-219-5200
-----------------------------------------------------
Fax | 321-281-8700
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 616788
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32861-6788
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-447-7120
-----------------------------------------------------
Fax | 407-770-0661
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Q00000X
-----------------------------------------------------
Taxonomy Name | Family Medicine Physician
-----------------------------------------------------
License Number | ME86418
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------