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NPI Code Detail

MEDICARE: PREMIER OBSTETRICS AND GYNECOLOGY OF ORLANDO, PA

MEDICARE: PREMIER OBSTETRICS AND GYNECOLOGY OF ORLANDO, PA
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
1174400000XSpecialist

General Provider Information

NPI Number : 1306821194
Entity Type Code : Organization
Provider Name (Legal Business Name) : PREMIER OBSTETRICS AND GYNECOLOGY OF ORLANDO, PA
Provider Business Mailing Address
First Line : 531 N MAITLAND AVE
Second Line :
City : MAITLAND
State : FL
Zip : 32751-4421
Country : US
Telephone Number : 321-397-1212
Fax Number : 321-397-1213
Provider Business Practice Location Address
First Line : 531 N MAITLAND AVE
Second Line :
City : MAITLAND
State : FL
Zip : 32751-4421
Country : US
Telephone Number : 321-397-1212
Fax Number : 321-397-1213
Authorized Official
Title or Position : PRESIDENT
Name : DR. JOHN WEST VAN WERT
Credential : M.D.
Telephone Number : 321-397-1212
Provider Enumeration Date : 12/14/2005
Last Update Date : 08/22/2020

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Directions to “PREMIER OBSTETRICS AND GYNECOLOGY OF ORLANDO, PA ” Practice Location

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