Provider Demographics
NPI:1114336740
Name:PHYSICIAN NEXT DOOR, LLC
Entity Type:Organization
Organization Name:PHYSICIAN NEXT DOOR, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GABRIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:NURIEL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:941-870-0199
Mailing Address - Street 1:1834 N ALAFAYA TRL
Mailing Address - Street 2:SUITE C
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32826-4743
Mailing Address - Country:US
Mailing Address - Phone:941-870-0199
Mailing Address - Fax:941-870-0203
Practice Address - Street 1:1834 N ALAFAYA TRL
Practice Address - Street 2:SUITE C
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32826-4743
Practice Address - Country:US
Practice Address - Phone:941-870-0199
Practice Address - Fax:941-870-0203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7691207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHM571AOtherPTAN