Provider Demographics
NPI:1346556008
Name:FLORIDA INJURY GROUP, LLC
Entity Type:Organization
Organization Name:FLORIDA INJURY GROUP, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:A
Authorized Official - Last Name:DEMETREE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-439-7122
Mailing Address - Street 1:PO BOX 161449
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32716-1449
Mailing Address - Country:US
Mailing Address - Phone:321-439-7122
Mailing Address - Fax:321-248-0387
Practice Address - Street 1:797 N SR 434
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-7233
Practice Address - Country:US
Practice Address - Phone:321-439-7122
Practice Address - Fax:321-248-0387
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-19
Last Update Date:2010-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty