=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891184271
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DC PEDIATRICS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/22/2015
-----------------------------------------------------
Last Update Date | 01/22/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1603 S HIAWASSEE RD SUITE 110
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32835-6438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-578-8600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1603 S HIAWASSEE RD SUITE 110
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32835-6438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-578-8600
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DAVID CRISPIN SR.
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 407-578-8600
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | ME93409
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------