Provider Demographics
NPI:1447790597
Name:PHYSICIANS MEDICAL AND INJURY GROUP EAST ORLANDO
Entity Type:Organization
Organization Name:PHYSICIANS MEDICAL AND INJURY GROUP EAST ORLANDO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:FREDERICK
Authorized Official - Last Name:VON BARGEN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:407-450-6991
Mailing Address - Street 1:7163 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-6724
Mailing Address - Country:US
Mailing Address - Phone:321-441-4944
Mailing Address - Fax:407-636-8749
Practice Address - Street 1:7163 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-6724
Practice Address - Country:US
Practice Address - Phone:321-441-4944
Practice Address - Fax:407-636-8749
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-07
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH10928111N00000X
FLOS9286204D00000X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMMGroup - Multi-Specialty