Provider Demographics
NPI:1619906567
Name:EAST ORLANDO FAMILY MEDICINE ASSOCIATES PA
Entity Type:Organization
Organization Name:EAST ORLANDO FAMILY MEDICINE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:C
Authorized Official - Last Name:MALLONEE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-249-3077
Mailing Address - Street 1:PO BOX 781789
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32878-1789
Mailing Address - Country:US
Mailing Address - Phone:407-249-3077
Mailing Address - Fax:407-249-3017
Practice Address - Street 1:12301 LAKE UNDERHILL RD
Practice Address - Street 2:SUITE 219
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-4508
Practice Address - Country:US
Practice Address - Phone:407-249-3077
Practice Address - Fax:407-249-3017
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-02
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5964207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK0104Medicare PIN