Provider Demographics
NPI:1770656571
Name:MID FLORIDA OB-GYN SPECIALISTS
Entity Type:Organization
Organization Name:MID FLORIDA OB-GYN SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:MOWERE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-322-5313
Mailing Address - Street 1:1403 MEDICAL PLAZA DR.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:SANFORD
Mailing Address - State:FL
Mailing Address - Zip Code:32771-1047
Mailing Address - Country:US
Mailing Address - Phone:407-322-5313
Mailing Address - Fax:407-321-4027
Practice Address - Street 1:1403 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 102
Practice Address - City:SANFORD
Practice Address - State:FL
Practice Address - Zip Code:32771-1000
Practice Address - Country:US
Practice Address - Phone:407-322-5313
Practice Address - Fax:407-321-4027
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL21985Medicare ID - Type Unspecified