Provider Demographics
NPI:1124033972
Name:MEDICAL DEVELOPMENT AND SUPPORT CORPORATION
Entity Type:Organization
Organization Name:MEDICAL DEVELOPMENT AND SUPPORT CORPORATION
Other - Org Name:ORTHOPAEDICS CENTER OF BRANDON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FABIO
Authorized Official - Middle Name:F
Authorized Official - Last Name:FIORE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-651-9888
Mailing Address - Street 1:803 S PARSONS AVE
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511
Mailing Address - Country:US
Mailing Address - Phone:813-651-9888
Mailing Address - Fax:813-654-0362
Practice Address - Street 1:803 S PARSONS AVE
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511
Practice Address - Country:US
Practice Address - Phone:813-651-9888
Practice Address - Fax:813-654-0362
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2012-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0056708207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL053401300Medicaid
FLK8461Medicare PIN
FL053401300Medicaid