Provider Demographics
NPI:1912196841
Name:MID-FLORIDA INFECTIOUS DISEASE, PA
Entity Type:Organization
Organization Name:MID-FLORIDA INFECTIOUS DISEASE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:RYAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-894-6618
Mailing Address - Street 1:PO BOX 568863
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32856-8863
Mailing Address - Country:US
Mailing Address - Phone:407-894-6618
Mailing Address - Fax:407-894-6619
Practice Address - Street 1:280 PATTERSON RD
Practice Address - Street 2:SUITE 4
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-6261
Practice Address - Country:US
Practice Address - Phone:863-422-8123
Practice Address - Fax:863-422-8725
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-16
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME69417207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG19008Medicare UPIN