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General NPI Number Information
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NPI Number | 1699953521
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Entity Type | Organization
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Legal Business Name | SEMINOLE SPORTS & FAMILY MEDICINE, PA
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Dates
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Enumeration Date | 02/01/2008
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Last Update Date | 10/09/2019
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Provider Practice Location Address
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Address Line | 798 EXECUTIVE DR
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City | OVIEDO
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State | FL
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Zip | 32765
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Country | US
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Telephone | 407-359-8580
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Fax | 407-359-8364
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Provider Business Mailing Address
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Address Line | 798 EXECUTIVE DR
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City | OVIEDO
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State | FL
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Zip | 32765-6392
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Country | US
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Telephone | 407-359-8580
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Fax | 407-359-8364
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MATTHEW ROSEN
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Credential | M.D.
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Telephone | 407-359-8580
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | ME73173
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License Number State | FL
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