Provider Demographics
NPI:1205894136
Name:MLB ORLANDO, INC
Entity type:Organization
Organization Name:MLB ORLANDO, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:V
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-856-0110
Mailing Address - Street 1:4401 S ORANGE AVE
Mailing Address - Street 2:#117
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-6946
Mailing Address - Country:US
Mailing Address - Phone:407-856-0110
Mailing Address - Fax:407-850-9645
Practice Address - Street 1:4401 S ORANGE AVE
Practice Address - Street 2:#117
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-6946
Practice Address - Country:US
Practice Address - Phone:407-856-0110
Practice Address - Fax:407-850-9645
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
Not Answered2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty
Not Answered207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL77681OtherBC/BS OF FLORIDA