Provider Demographics
NPI:1417249830
Name:FAMILY MEDICINE OF ORLANDO PLLC
Entity Type:Organization
Organization Name:FAMILY MEDICINE OF ORLANDO PLLC
Other - Org Name:ORLANDO PHYSICIANS PRACTICE, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:RSA
Authorized Official - Last Name:HAY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:718-324-3611
Mailing Address - Street 1:2295 S HIAWASSEE RD STE 210
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-8748
Mailing Address - Country:US
Mailing Address - Phone:407-802-3233
Mailing Address - Fax:407-233-4010
Practice Address - Street 1:2295 S HIAWASSEE RD STE 210
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-8748
Practice Address - Country:US
Practice Address - Phone:407-802-3233
Practice Address - Fax:407-233-4010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-03
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10206207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLDL016ZMedicare Oscar/Certification