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General NPI Number Information
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NPI Number | 1649228834
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Entity Type | Organization
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Legal Business Name | ORLANDO DERMATOLOGY, INC.
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Dates
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Enumeration Date | 05/04/2006
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Last Update Date | 05/16/2024
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Provider Practice Location Address
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Address Line | 6000 TURKEY LAKE RD SUITE 110
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City | ORLANDO
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State | FL
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Zip | 32819
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Country | US
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Telephone | 407-351-1888
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Fax | 407-226-9804
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Provider Business Mailing Address
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Address Line | 8827 SOUTHERN BREEZE DR
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City | ORLANDO
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State | FL
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Zip | 32836-5034
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Country | US
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Telephone | 321-663-1888
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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. FAROOQ LATEEF
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Credential | M.D.
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Telephone | 407-351-1888
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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 | ME75932
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number |
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License Number State |
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