Provider Demographics
NPI:1710977251
Name:FLORIDA SURGICAL GROUP, P.A.
Entity Type:Organization
Organization Name:FLORIDA SURGICAL GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFERY
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:CRYAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-834-6965
Mailing Address - Street 1:661 E ALTAMONTE DR
Mailing Address - Street 2:SUITE 323
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-5105
Mailing Address - Country:US
Mailing Address - Phone:407-834-6965
Mailing Address - Fax:407-834-0424
Practice Address - Street 1:661 E ALTAMONTE DR
Practice Address - Street 2:SUITE 323
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32701-5105
Practice Address - Country:US
Practice Address - Phone:407-834-6965
Practice Address - Fax:407-834-0424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-26
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL370052600Medicaid
FL370052600Medicaid