MEDICARE: FAMILY CARE DOCTORS GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1053593855
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY CARE DOCTORS GROUP LLC

Provider Business Mailing Address
First Line	:	10244 E COLONIAL DR
Second Line	:	STE 102
City	:	ORLANDO
State	:	FL
Zip	:	32817-4374
Country	:	US
Telephone Number	:	407-382-4217
Fax Number	:

Provider Business Practice Location Address
First Line	:	10244 E COLONIAL DR
Second Line	:	STE 102
City	:	ORLANDO
State	:	FL
Zip	:	32817-4374
Country	:	US
Telephone Number	:	407-382-4217
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	EDNA TORRES
Credential	:
Telephone Number	:	407-382-4217

Provider Enumeration Date	:	12/04/2007
Last Update Date	:	12/04/2007

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