Provider Demographics
NPI:1639448525
Name:NORMA L WAITE MD - MEDICAL GROUP LLC
Entity Type:Organization
Organization Name:NORMA L WAITE MD - MEDICAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NORMA
Authorized Official - Middle Name:L
Authorized Official - Last Name:WAITE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-363-9499
Mailing Address - Street 1:6000 TURKEY LAKE RD
Mailing Address - Street 2:SUITE NUMBER 112
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-4200
Mailing Address - Country:US
Mailing Address - Phone:407-363-9499
Mailing Address - Fax:407-363-9622
Practice Address - Street 1:6000 TURKEY LAKE RD
Practice Address - Street 2:SUITE NUMBER 112
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-4200
Practice Address - Country:US
Practice Address - Phone:407-363-9499
Practice Address - Fax:407-363-9622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-21
Last Update Date:2011-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0037750207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty