Provider Demographics
NPI:1558715250
Name:THE FLORIDA KNEE AND ORTHOPEDIC PAVILION, P.A.
Entity Type:Organization
Organization Name:THE FLORIDA KNEE AND ORTHOPEDIC PAVILION, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:GARY
Authorized Official - Last Name:HAYTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-953-9492
Mailing Address - Street 1:1831 N BELCHER RD
Mailing Address - Street 2:SUITE E-2
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-1449
Mailing Address - Country:US
Mailing Address - Phone:727-953-9492
Mailing Address - Fax:727-470-9457
Practice Address - Street 1:1831 N BELCHER RD
Practice Address - Street 2:SUITE E-2
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1449
Practice Address - Country:US
Practice Address - Phone:727-953-9492
Practice Address - Fax:727-470-9457
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-19
Last Update Date:2016-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372802100Medicaid
FL372802100Medicaid