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General NPI Number Information
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NPI Number | 1629568159
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Entity Type | Organization
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Legal Business Name | FORTIS MEDICAL GROUP, LLC
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Dates
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Enumeration Date | 05/10/2018
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Last Update Date | 05/10/2018
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Provider Practice Location Address
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Address Line | 1803 PARK CENTER DR STE 103
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City | ORLANDO
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State | FL
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Zip | 32835-6216
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Country | US
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Telephone | 407-286-1875
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Fax | 407-386-8000
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Provider Business Mailing Address
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Address Line | 1803 PARK CENTER DR STE 103
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City | ORLANDO
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State | FL
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Zip | 32835-6216
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Country | US
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Telephone | 407-286-1875
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Fax | 407-386-8000
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. JAGMOHAN N VIROJA
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Credential | MD
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Telephone | 407-286-1875
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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 | ME83974
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License Number State | FL
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