Provider Demographics
NPI:1548400807
Name:JEROME A AFRICK M D P A
Entity Type:Organization
Organization Name:JEROME A AFRICK M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEROME
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:AFRICK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-339-4441
Mailing Address - Street 1:321 MAITLAND AVE
Mailing Address - Street 2:SUITE 1500
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5449
Mailing Address - Country:US
Mailing Address - Phone:407-339-4441
Mailing Address - Fax:407-339-6557
Practice Address - Street 1:321 MAITLAND AVE
Practice Address - Street 2:SUITE 1500
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5449
Practice Address - Country:US
Practice Address - Phone:407-339-4441
Practice Address - Fax:407-339-6557
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-26
Last Update Date:2009-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 13882174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLP55425Medicare UPIN