Provider Demographics
NPI:1114901816
Name:WINTER PARK FAMILY HEALTH CENTER INC
Entity Type:Organization
Organization Name:WINTER PARK FAMILY HEALTH CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:LORIN
Authorized Official - Last Name:SHAW
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-679-9222
Mailing Address - Street 1:2304 ALOMA AVE
Mailing Address - Street 2:100
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-3330
Mailing Address - Country:US
Mailing Address - Phone:407-679-9222
Mailing Address - Fax:407-679-9061
Practice Address - Street 1:2304 ALOMA AVE STE 100
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3330
Practice Address - Country:US
Practice Address - Phone:407-679-9222
Practice Address - Fax:407-679-9061
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-06
Last Update Date:2015-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1316213507OtherNPI FOR LINDSEY NEWMAN DEFRESNE, DO
MI1639373962OtherDR. PRISKA'S NPI
FL40471OtherWINTER PARK MEDICARE GROUP NUMBER
FL48983ZOtherRONALD STANISH MD
FL1922099555OtherRONALD L SHAW MD NPI
FL47663YOtherRONALD L. SHAW MD MEDICARE PTAN