=====================================================
General NPI Number Information
=====================================================
NPI Number | 1598124372
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GAP MEDICAL CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2016
-----------------------------------------------------
Last Update Date | 02/22/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1674 S ORANGE BLOSSOM TRL
-----------------------------------------------------
City | APOPKA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32703-7754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-814-9011
-----------------------------------------------------
Fax | 407-814-8424
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1674 S ORANGE BLOSSOM TRL
-----------------------------------------------------
City | APOPKA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32703-7754
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-814-9011
-----------------------------------------------------
Fax | 407-814-8424
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. REGINALD BOWDEN
-----------------------------------------------------
Credential | M.D
-----------------------------------------------------
Telephone | 407-814-9011
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QU0200X
-----------------------------------------------------
Taxonomy Name | Urgent Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------