Provider Demographics
NPI:1649064239
Name:FLORIDAMD CLINIC PA
Entity type:Organization
Organization Name:FLORIDAMD CLINIC PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:
Authorized Official - Last Name:LOPEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-401-1027
Mailing Address - Street 1:210 N WESTMONTE DR # 1001
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3311
Mailing Address - Country:US
Mailing Address - Phone:407-663-0401
Mailing Address - Fax:407-606-8874
Practice Address - Street 1:210 N WESTMONTE DR # 1001
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3311
Practice Address - Country:US
Practice Address - Phone:407-663-0401
Practice Address - Fax:407-606-8874
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-08
Last Update Date:2025-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty