Provider Demographics
NPI:1023567229
Name:ORLANDO PHYSICIAN SPECIALISTS LLC
Entity Type:Organization
Organization Name:ORLANDO PHYSICIAN SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:WITTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-303-7869
Mailing Address - Street 1:1561 W FAIRBANKS AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4678
Mailing Address - Country:US
Mailing Address - Phone:407-332-7700
Mailing Address - Fax:
Practice Address - Street 1:2250 BEDFORD RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-1443
Practice Address - Country:US
Practice Address - Phone:407-303-7869
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-28
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME92559208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty