Provider Demographics
NPI:1578832473
Name:ORLANDO PHYSICIAN SPECIALISTS LLC
Entity Type:Organization
Organization Name:ORLANDO PHYSICIAN SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHYAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:PARYANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-309-8680
Mailing Address - Street 1:PO BOX 19634
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32245-9634
Mailing Address - Country:US
Mailing Address - Phone:904-309-8680
Mailing Address - Fax:904-345-5841
Practice Address - Street 1:405 S PARK AVE
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-5261
Practice Address - Country:US
Practice Address - Phone:407-884-7774
Practice Address - Fax:407-884-9770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0027JOtherBCBS
FL0027JOtherBCBS
FLFG093BMedicare PIN