Provider Demographics
NPI:1669567855
Name:SERRAO, EGBERT JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:EGBERT
Middle Name:JOHN
Last Name:SERRAO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2905 MCRAE AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803
Mailing Address - Country:US
Mailing Address - Phone:407-897-2230
Mailing Address - Fax:407-897-1111
Practice Address - Street 1:2905 MCRAE AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803
Practice Address - Country:US
Practice Address - Phone:407-897-2230
Practice Address - Fax:407-897-1111
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME50482207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E17799Medicare UPIN