Provider Demographics
NPI:1043604929
Name:THE FAMILY DOCTORS, LLC
Entity Type:Organization
Organization Name:THE FAMILY DOCTORS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGRM
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BAUTISTA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-348-0399
Mailing Address - Street 1:14050 TOWN LOOP BLVD
Mailing Address - Street 2:STE. 201
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-6190
Mailing Address - Country:US
Mailing Address - Phone:407-348-0399
Mailing Address - Fax:407-348-8350
Practice Address - Street 1:14050 TOWN LOOP BLVD
Practice Address - Street 2:STE. 201
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-6190
Practice Address - Country:US
Practice Address - Phone:407-348-0399
Practice Address - Fax:407-348-8350
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-27
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME62124207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty