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General NPI Number Information
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NPI Number | 1952375388
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Entity Type | Organization
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Legal Business Name | ALOMA PARK OB/GYN PA
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Dates
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Enumeration Date | 02/14/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1925 MIZELL AVE STE 104
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City | WINTER PARK
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State | FL
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Zip | 32792
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Country | US
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Telephone | 407-657-4407
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Fax | 407-657-4669
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Provider Business Mailing Address
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Address Line | 1925 MIZELL AVE STE 104
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City | WINTER PARK
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State | FL
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Zip | 32792
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Country | US
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Telephone | 407-657-4407
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Fax | 407-657-4669
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Authorized Official
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Title or Position | PRESIDENT
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Name | BERNARD THOMAS DESPRES
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Credential | DO
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Telephone | 407-657-4407
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | OS0005626
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License Number State | FL
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