Provider Demographics
NPI:1861672479
Name:UNIVERSITY FAMILY MEDICINE CENTER PA
Entity Type:Organization
Organization Name:UNIVERSITY FAMILY MEDICINE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:R
Authorized Official - Last Name:BURNS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-679-4800
Mailing Address - Street 1:10055 UNIVERSITY BLVD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32817-1902
Mailing Address - Country:US
Mailing Address - Phone:407-679-4800
Mailing Address - Fax:407-679-0574
Practice Address - Street 1:10055 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32817-1902
Practice Address - Country:US
Practice Address - Phone:407-679-4800
Practice Address - Fax:407-679-0574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-12
Last Update Date:2010-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL39205Medicare PIN