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General NPI Number Information
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NPI Number | 1881065324
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Entity Type | Organization
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Legal Business Name | PRIXUS MEDICAL GROUP LLC
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Dates
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Enumeration Date | 10/09/2015
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Last Update Date | 10/11/2024
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Provider Practice Location Address
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Address Line | 8624 LEE VISTA BLVD
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City | ORLANDO
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State | FL
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Zip | 32829-8383
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Country | US
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Telephone | 787-671-0051
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Fax |
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Provider Business Mailing Address
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Address Line | 12092 JEWEL FISH LN
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City | ORLANDO
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State | FL
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Zip | 32827-7141
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. RAPHAEL BONES
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Credential |
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Telephone | 407-720-3209
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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 | ME116549
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License Number State | FL
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