Provider Demographics
NPI:1780711101
Name:DELANEY PARK FAMILY PRACTICE
Entity type:Organization
Organization Name:DELANEY PARK FAMILY PRACTICE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LOUIS
Authorized Official - Middle Name:C
Authorized Official - Last Name:MURRAY
Authorized Official - Suffix:SR
Authorized Official - Credentials:MD
Authorized Official - Phone:407-423-2571
Mailing Address - Street 1:900 DELANEY AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-1246
Mailing Address - Country:US
Mailing Address - Phone:407-423-2571
Mailing Address - Fax:407-423-0028
Practice Address - Street 1:900 DELANEY AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1246
Practice Address - Country:US
Practice Address - Phone:407-423-2571
Practice Address - Fax:407-423-0028
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0005668207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL45142Medicare ID - Type Unspecified