Provider Demographics
NPI:1669759270
Name:CENTRAL FLORIDA PRIMARY PHYSICIANS
Entity type:Organization
Organization Name:CENTRAL FLORIDA PRIMARY PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDRES
Authorized Official - Middle Name:F
Authorized Official - Last Name:VELASCO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-574-1423
Mailing Address - Street 1:1565 SAXON BLVD
Mailing Address - Street 2:STE 103
Mailing Address - City:DELTONA
Mailing Address - State:FL
Mailing Address - Zip Code:32725-5876
Mailing Address - Country:US
Mailing Address - Phone:386-574-1423
Mailing Address - Fax:386-860-9239
Practice Address - Street 1:8865 COMMODITY CIR
Practice Address - Street 2:STE 7
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-9077
Practice Address - Country:US
Practice Address - Phone:407-720-3523
Practice Address - Fax:407-720-3524
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-10
Last Update Date:2015-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME96936207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI49036TXMedicare UPIN