Provider Demographics
NPI:1952685356
Name:ACTIVE ORTHOPEDICS, LLC
Entity Type:Organization
Organization Name:ACTIVE ORTHOPEDICS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WENDELL
Authorized Official - Middle Name:
Authorized Official - Last Name:BULMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-538-8865
Mailing Address - Street 1:755 COUNTY ROAD 1
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34683-6306
Mailing Address - Country:US
Mailing Address - Phone:813-864-3998
Mailing Address - Fax:813-864-3141
Practice Address - Street 1:775 COUNTY ROAD 1
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34683-6306
Practice Address - Country:US
Practice Address - Phone:727-538-8865
Practice Address - Fax:727-539-8726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-04
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOS7010OtherMEDICAL LICENSE