=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912303306
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEST ORANGE COUNTY PEDIATRICS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2014
-----------------------------------------------------
Last Update Date | 11/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7148 CURRY FORD RD SUITE 200
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32822-5803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-273-1357
-----------------------------------------------------
Fax | 407-273-9028
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7148 CURRY FORD RD SUITE 200
-----------------------------------------------------
City | ORLANDO
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 32822-5803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 407-273-1357
-----------------------------------------------------
Fax | 407-273-9028
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PEDIATRICIAN
-----------------------------------------------------
Name | DR. GERARDO M. DURAN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 407-273-1357
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number | ME0063905
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------