Provider Demographics
NPI:1346567484
Name:LAUREL OAKS FAMILY PRACTICE OF CENTRAL FLORIDA PA
Entity Type:Organization
Organization Name:LAUREL OAKS FAMILY PRACTICE OF CENTRAL FLORIDA PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:BRADLEY
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:407-877-1990
Mailing Address - Street 1:2711 MAGUIRE RD
Mailing Address - Street 2:
Mailing Address - City:OCOEE
Mailing Address - State:FL
Mailing Address - Zip Code:34761-4797
Mailing Address - Country:US
Mailing Address - Phone:407-877-1990
Mailing Address - Fax:407-877-1995
Practice Address - Street 1:2711 MAGUIRE RD
Practice Address - Street 2:
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4797
Practice Address - Country:US
Practice Address - Phone:407-877-1990
Practice Address - Fax:407-877-1995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-29
Last Update Date:2010-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7986207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty