Provider Demographics
NPI:1598920613
Name:CENTRAL FLORIDA PLASTIC SURGERY PA
Entity Type:Organization
Organization Name:CENTRAL FLORIDA PLASTIC SURGERY PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FERNANDO
Authorized Official - Middle Name:G
Authorized Official - Last Name:SERRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-259-0722
Mailing Address - Street 1:910 OLD CAMP RD
Mailing Address - Street 2:STE 142
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-5604
Mailing Address - Country:US
Mailing Address - Phone:352-259-0722
Mailing Address - Fax:352-259-0721
Practice Address - Street 1:910 OLD CAMP RD
Practice Address - Street 2:STE 142
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5604
Practice Address - Country:US
Practice Address - Phone:352-259-0722
Practice Address - Fax:352-259-0721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME76142174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLAN197Medicare PIN