Provider Demographics
NPI:1346285293
Name:VIVES, EMILY (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:
Last Name:VIVES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:VIVES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11183 S ORANGE BLOSSOM TRL
Mailing Address - Street 2:SUITE 204D
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32837-9402
Mailing Address - Country:US
Mailing Address - Phone:407-850-0103
Mailing Address - Fax:407-850-9901
Practice Address - Street 1:11183 S ORANGE BLOSSOM TRL
Practice Address - Street 2:UNIT 204 D
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32837-9402
Practice Address - Country:US
Practice Address - Phone:407-850-0103
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2017-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME84737207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL265342700Medicaid
FLE8065AMedicare ID - Type Unspecified
FL265342700Medicaid