MEDICARE: VMD PRIMARY PROVIDERS CENTRAL FLORIDA PLLC

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	207R00000X	Internal Medicine Physician
2	207Q00000X	Family Medicine Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215696158
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VMD PRIMARY PROVIDERS CENTRAL FLORIDA PLLC

Provider Business Mailing Address
First Line	:	4650 WESTWAY PARK BLVD
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77041-2007
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5340 SOUTEL DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32219-3478
Country	:	US
Telephone Number	:	407-798-8800
Fax Number	:	321-333-4292

Authorized Official
Title or Position	:	DIRECTOR REVENUE CYCLE
Name	:	REBECCA RAGER
Credential	:
Telephone Number	:	844-969-0686

Provider Enumeration Date	:	12/08/2021
Last Update Date	:	01/14/2025

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