Provider Demographics
NPI:1952375388
Name:ALOMA PARK OB/GYN PA
Entity Type:Organization
Organization Name:ALOMA PARK OB/GYN PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BERNARD
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:DESPRES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:407-657-4407
Mailing Address - Street 1:1925 MIZELL AVE
Mailing Address - Street 2:STE 104
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792
Mailing Address - Country:US
Mailing Address - Phone:407-657-4407
Mailing Address - Fax:407-657-4669
Practice Address - Street 1:1925 MIZELL AVE
Practice Address - Street 2:STE 104
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32792
Practice Address - Country:US
Practice Address - Phone:407-657-4407
Practice Address - Fax:407-657-4669
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS0005626207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E80143Medicare UPIN
80451Medicare ID - Type Unspecified