MEDICARE: CENTRAL FLORIDA PRIMARY PHYSICIANS

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	ME96936	FL

General Provider Information

NPI Number	:	1669759270
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL FLORIDA PRIMARY PHYSICIANS

Provider Business Mailing Address
First Line	:	1565 SAXON BLVD
Second Line	:	STE 103
City	:	DELTONA
State	:	FL
Zip	:	32725-5876
Country	:	US
Telephone Number	:	386-574-1423
Fax Number	:	386-860-9239

Provider Business Practice Location Address
First Line	:	8865 COMMODITY CIR
Second Line	:	STE 7
City	:	ORLANDO
State	:	FL
Zip	:	32819-9077
Country	:	US
Telephone Number	:	407-720-3523
Fax Number	:	407-720-3524

Authorized Official
Title or Position	:	OWNER
Name	:	MR. ANDRES F VELASCO
Credential	:	MD
Telephone Number	:	386-574-1423

Provider Enumeration Date	:	11/10/2011
Last Update Date	:	09/30/2015

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