MEDICARE: FLORIDAMD CLINIC 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
1	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	:	1649064239
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FLORIDAMD CLINIC PA

Provider Business Mailing Address
First Line	:	210 N WESTMONTE DR # 1001
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-3311
Country	:	US
Telephone Number	:	407-663-0401
Fax Number	:	407-214-2749

Provider Business Practice Location Address
First Line	:	210 N WESTMONTE DR # 1001
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-3311
Country	:	US
Telephone Number	:	407-663-0401
Fax Number	:	407-606-8874

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. JOSE LUIS LOPEZ RIVERA
Credential	:	MD
Telephone Number	:	407-633-0401

Provider Enumeration Date	:	04/08/2025
Last Update Date	:	06/03/2026

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Directions to “FLORIDAMD CLINIC PA ” Practice Location

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