Provider Demographics
NPI:1043386865
Name:DOCTORS MEMORIAL HOSPITAL
Entity Type:Organization
Organization Name:DOCTORS MEMORIAL HOSPITAL
Other - Org Name:DOCTORS MEMORIAL HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JAIME
Authorized Official - Middle Name:
Authorized Official - Last Name:MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-584-0800
Mailing Address - Street 1:DOCTORS MEMORIAL HOSPITAL
Mailing Address - Street 2:PO BOX 864013
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32886-4013
Mailing Address - Country:US
Mailing Address - Phone:850-584-0800
Mailing Address - Fax:
Practice Address - Street 1:DOCTORS MEMORIAL HOSPITAL
Practice Address - Street 2:333 N BYRON BUTLER PARKWAY
Practice Address - City:PERRY
Practice Address - State:FL
Practice Address - Zip Code:32347
Practice Address - Country:US
Practice Address - Phone:850-584-0800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherTAX IDENTIFICATION