MEDICARE: CENTRAL FLORIDA PRIMARY CARE 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	208600000X	Surgery Physician
2	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1699893701
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL FLORIDA PRIMARY CARE PA

Provider Business Mailing Address
First Line	:	172 S SEMORAN BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-3293
Country	:	US
Telephone Number	:	407-380-1951
Fax Number	:	407-380-1343

Provider Business Practice Location Address
First Line	:	172 S SEMORAN BLVD
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32807-3293
Country	:	US
Telephone Number	:	407-380-1951
Fax Number	:	407-380-1343

Authorized Official
Title or Position	:	PRESIDENT
Name	:	FLORENCIO ELLO
Credential	:	MD
Telephone Number	:	407-380-1951

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	12/30/2008

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Directions to “CENTRAL FLORIDA PRIMARY CARE PA ” Practice Location

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