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General NPI Number Information
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NPI Number | 1760818488
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Entity Type | Organization
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Legal Business Name | SEMORAN FAMILY HEALTH, LLC
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Dates
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Enumeration Date | 09/26/2013
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Last Update Date | 09/26/2013
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Provider Practice Location Address
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Address Line | 632 N SEMORAN BLVD
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City | ORLANDO
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State | FL
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Zip | 32807-3330
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Country | US
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Telephone | 407-205-3132
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Fax |
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Provider Business Mailing Address
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Address Line | 632 N SEMORAN BLVD
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City | ORLANDO
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State | FL
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Zip | 32807-3330
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Country | US
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Telephone | 407-205-3132
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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. RONALD C MALLONEE
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Credential | D.O.
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Telephone | 407-492-8950
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | OS6833
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License Number State | FL
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