Provider Demographics
NPI:1851433759
Name:UROLOGY ASSOCIATES OF CENTRAL FLORIDA
Entity Type:Organization
Organization Name:UROLOGY ASSOCIATES OF CENTRAL FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHELGREN
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:863-293-5100
Mailing Address - Street 1:427 E CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33880-3051
Mailing Address - Country:US
Mailing Address - Phone:863-293-5100
Mailing Address - Fax:863-679-3700
Practice Address - Street 1:427 E CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33880-3051
Practice Address - Country:US
Practice Address - Phone:863-293-5100
Practice Address - Fax:863-679-3700
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME39638208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK6657Medicare ID - Type Unspecified
FLD56616Medicare UPIN