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General NPI Number Information
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NPI Number | 1528111085
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Entity Type | Organization
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Legal Business Name | CENTRAL FLORIDA MEDICAL ASSOCIATES, INC
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Dates
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Enumeration Date | 01/19/2007
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Last Update Date | 01/12/2015
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Provider Practice Location Address
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Address Line | 2555 S VOLUSIA AVE
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City | ORANGE CITY
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State | FL
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Zip | 32763-9135
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Country | US
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Telephone | 386-774-0401
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Fax | 386-774-5783
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Provider Business Mailing Address
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Address Line | 2555 S VOLUSIA AVE
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City | ORANGE CITY
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State | FL
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Zip | 32763-9135
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Country | US
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Telephone | 386-774-0401
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Fax | 386-774-5783
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MRS. ILENE BALLENTINE
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Credential |
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Telephone | 386-774-0401
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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 | ME75141
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License Number State | FL
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