Provider Demographics
NPI:1134566813
Name:ORLANDO PHYSICIAN SPECIALISTS LLC
Entity type:Organization
Organization Name:ORLANDO PHYSICIAN SPECIALISTS LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHYAM
Authorized Official - Middle Name:B
Authorized Official - Last Name:PARYANI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-309-8680
Mailing Address - Street 1:3599 UNIVERSITY BLVD S
Mailing Address - Street 2:SUITE 907
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-4252
Mailing Address - Country:US
Mailing Address - Phone:904-309-8680
Mailing Address - Fax:904-345-5841
Practice Address - Street 1:7252 NARCOOSSEE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32822-5550
Practice Address - Country:US
Practice Address - Phone:407-482-1234
Practice Address - Fax:407-478-4921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-04
Last Update Date:2014-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004206306Medicaid
FL0027JOtherBCBS
FL004206306Medicaid
FLFG093AMedicare PIN