=====================================================
General NPI Number Information
=====================================================
NPI Number | 1649547084
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ORTHOPEDIC ASSOCIATES, PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/30/2011
-----------------------------------------------------
Last Update Date | 01/11/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 220 N SYKES CREEK PKWY SUITE 200
-----------------------------------------------------
City | MERRITT ISLAND
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32953-3489
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-459-1446
-----------------------------------------------------
Fax | 321-452-1261
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 225 N ATLANTIC AVE SUITE 603
-----------------------------------------------------
City | COCOA BEACH
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32931-4315
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 321-459-1446
-----------------------------------------------------
Fax | 321-452-1261
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/SURGEON
-----------------------------------------------------
Name | DR. JEROME GUZMAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 321-459-1446
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207X00000X
-----------------------------------------------------
Taxonomy Name | Orthopaedic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------