Provider Demographics
NPI:1265463343
Name:THE ORLANDO CLINIC FOR ASTHMA AND RESPIRATORY DISEASES
Entity Type:Organization
Organization Name:THE ORLANDO CLINIC FOR ASTHMA AND RESPIRATORY DISEASES
Other - Org Name:PUTNAM PULMONARY PRACTICE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICAL MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:HERSEY
Authorized Official - Last Name:FEIBELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-530-2749
Mailing Address - Street 1:700 ZEAGLER DR STE 6
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-3826
Mailing Address - Country:US
Mailing Address - Phone:386-530-2749
Mailing Address - Fax:386-530-2749
Practice Address - Street 1:700 ZEAGLER DR STE 6
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-3826
Practice Address - Country:US
Practice Address - Phone:386-530-2749
Practice Address - Fax:386-530-2735
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2019-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME38708207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK2297Medicare PIN