Provider Demographics
NPI:1114049822
Name:WINDERMERE PEDIATRICS
Entity Type:Organization
Organization Name:WINDERMERE PEDIATRICS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GINNY
Authorized Official - Middle Name:L
Authorized Official - Last Name:GUYTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-297-0080
Mailing Address - Street 1:2101 PARK CENTER DR
Mailing Address - Street 2:100 & 130
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-7626
Mailing Address - Country:US
Mailing Address - Phone:407-297-0080
Mailing Address - Fax:407-295-3080
Practice Address - Street 1:2101 PARK CENTER DR
Practice Address - Street 2:100 & 130
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-7626
Practice Address - Country:US
Practice Address - Phone:407-297-0080
Practice Address - Fax:407-295-3080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0051702208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0051702OtherMEDICAL LICENSE
FLBG1593878OtherDEA NUMBER
FLE22905Medicare UPIN