Provider Demographics
NPI:1417111352
Name:CENTRAL FLORIDA UROLOGY GROUP PA
Entity Type:Organization
Organization Name:CENTRAL FLORIDA UROLOGY GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:L
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-351-2801
Mailing Address - Street 1:40 SW 12TH ST
Mailing Address - Street 2:A201
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-6525
Mailing Address - Country:US
Mailing Address - Phone:352-351-2801
Mailing Address - Fax:352-351-2279
Practice Address - Street 1:40 SW 12TH ST
Practice Address - Street 2:A201
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-6525
Practice Address - Country:US
Practice Address - Phone:352-351-2801
Practice Address - Fax:352-351-2279
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-10
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLA06503Medicare UPIN
FLAL413Medicare PIN