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General NPI Number Information
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NPI Number | 1912296344
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Entity Type | Organization
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Legal Business Name | COMPLETE HEALTH EXPRESS
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Dates
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Enumeration Date | 04/06/2011
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Last Update Date | 04/06/2011
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Provider Practice Location Address
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Address Line | 201 S ORANGE AVE
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City | ORLANDO
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State | FL
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Zip | 32801-3413
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Country | US
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Telephone | 407-895-4737
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Fax | 407-896-8262
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Provider Business Mailing Address
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Address Line | 891 OUTER RD SUITE A
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City | ORLANDO
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State | FL
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Zip | 32814-6605
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Country | US
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Telephone | 407-895-4737
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Fax | 407-896-8262
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Authorized Official
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Title or Position | OWNER AND ADMINISTRATOR
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Name | DR. CHRISTOPHER J BROUILLETTE
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Credential | M.D.
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Telephone | 407-895-4737
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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 | ME76609
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License Number State | FL
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