Provider Demographics
NPI:1316226657
Name:ORANGE DOC FAMILY MEDICINE,PLLC
Entity Type:Organization
Organization Name:ORANGE DOC FAMILY MEDICINE,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ADOLFO
Authorized Official - Middle Name:ENRIQUE
Authorized Official - Last Name:TERAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:305-804-5575
Mailing Address - Street 1:PO BOX 120325
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34712-0325
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:835 7TH ST
Practice Address - Street 2:SUITE 5
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2190
Practice Address - Country:US
Practice Address - Phone:305-804-5575
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-04
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care