Provider Demographics
NPI:1912129156
Name:CENTRAL FLORIDA SURGICAL ASSOCIATES PA
Entity Type:Organization
Organization Name:CENTRAL FLORIDA SURGICAL ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SURGEON
Authorized Official - Prefix:DR
Authorized Official - First Name:MALCOLM
Authorized Official - Middle Name:HUGH
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-677-6500
Mailing Address - Street 1:5415 LAKE HOWELL RD # 175
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-1033
Mailing Address - Country:US
Mailing Address - Phone:407-677-6500
Mailing Address - Fax:407-671-9593
Practice Address - Street 1:3009 ALOMA AVENUE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792-3701
Practice Address - Country:US
Practice Address - Phone:407-677-6500
Practice Address - Fax:407-671-9593
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0002437174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL378782600Medicaid
FL33992Medicare ID - Type UnspecifiedPROVIDER #