Provider Demographics
NPI:1972644631
Name:ALAFAYA WOODS FAMILY MEDICAL CENTER P A
Entity Type:Organization
Organization Name:ALAFAYA WOODS FAMILY MEDICAL CENTER P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFRY
Authorized Official - Middle Name:F
Authorized Official - Last Name:ROCKER
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-366-3577
Mailing Address - Street 1:110 ALAFAYA WOODS BLVD
Mailing Address - Street 2:
Mailing Address - City:OVIEDO
Mailing Address - State:FL
Mailing Address - Zip Code:32765-6241
Mailing Address - Country:US
Mailing Address - Phone:407-366-3577
Mailing Address - Fax:407-366-2646
Practice Address - Street 1:110 ALAFAYA WOODS BLVD
Practice Address - Street 2:
Practice Address - City:OVIEDO
Practice Address - State:FL
Practice Address - Zip Code:32765-6241
Practice Address - Country:US
Practice Address - Phone:407-366-3577
Practice Address - Fax:407-366-2646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2010-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0S0005703170100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes170100000XOther Service ProvidersMedical Genetics, Ph.D. Medical GeneticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCK9014OtherMEDICARE RAILROAD
FL45443Medicare PIN