MEDICARE: WINDERMERE ALLERGY & ASTHMA,INC

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	207K00000X	Allergy & Immunology Physician	ME68693	FL

General Provider Information

NPI Number	:	1447378054
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WINDERMERE ALLERGY & ASTHMA,INC

Provider Business Mailing Address
First Line	:	8946 CONROY WINDERMERE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-3128
Country	:	US
Telephone Number	:	407-876-1009
Fax Number	:	407-876-6742

Provider Business Practice Location Address
First Line	:	8946 CONROY WINDERMERE RD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32835-3128
Country	:	US
Telephone Number	:	407-876-1009
Fax Number	:	407-876-6742

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. DANA L BROUSSARD-PERRY
Credential	:	M.D.
Telephone Number	:	407-876-1009

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	11/02/2011

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