Provider Demographics
NPI:1235406885
Name:RMA OF SOUTH ORLANDO LLC
Entity Type:Organization
Organization Name:RMA OF SOUTH ORLANDO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:
Authorized Official - Last Name:DUDLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-318-6590
Mailing Address - Street 1:4151 HUNTERS PARK LN
Mailing Address - Street 2:SUITE 132
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-3617
Mailing Address - Country:US
Mailing Address - Phone:407-251-4486
Mailing Address - Fax:407-251-9386
Practice Address - Street 1:4151 HUNTERS PARK LN
Practice Address - Street 2:SUITE 132
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-3617
Practice Address - Country:US
Practice Address - Phone:407-251-4486
Practice Address - Fax:407-251-9386
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-28
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty