Provider Demographics
NPI:1699205310
Name:COLUMBIE SARDINAS, WILMER (MD)
Entity Type:Individual
Prefix:
First Name:WILMER
Middle Name:
Last Name:COLUMBIE SARDINAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6900 TAVISTOCK LAKES BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32827-7592
Mailing Address - Country:US
Mailing Address - Phone:321-332-6947
Mailing Address - Fax:407-286-4515
Practice Address - Street 1:7200 CURRY FORD RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-5806
Practice Address - Country:US
Practice Address - Phone:407-587-7552
Practice Address - Fax:407-757-0483
Is Sole Proprietor?:No
Enumeration Date:2017-06-14
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR19666208D00000X
FLACN964208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1699205310OtherNPI
PR07469000OtherECFMG
FL1699205310OtherNPI