Provider Demographics
NPI:1144773706
Name:ORLANDO PHYSICIAN SPECIALISTS LLC
Entity Type:Organization
Organization Name:ORLANDO PHYSICIAN SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:
Authorized Official - Last Name:WITTEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:214-648-5413
Mailing Address - Street 1:1561 W FAIRBANKS AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-4678
Mailing Address - Country:US
Mailing Address - Phone:407-478-4920
Mailing Address - Fax:
Practice Address - Street 1:830 29TH ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32805-6219
Practice Address - Country:US
Practice Address - Phone:407-843-3230
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty