Provider Demographics
NPI:1982370714
Name:MEDICAL ASSOCIATES OF CENTRAL FLORIDA PHYSICIANS, LLC
Entity Type:Organization
Organization Name:MEDICAL ASSOCIATES OF CENTRAL FLORIDA PHYSICIANS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-733-5713
Mailing Address - Street 1:31810 HWY 27
Mailing Address - Street 2:
Mailing Address - City:HAINES CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33844-7617
Mailing Address - Country:US
Mailing Address - Phone:863-877-2411
Mailing Address - Fax:
Practice Address - Street 1:31810 HWY 27
Practice Address - Street 2:
Practice Address - City:HAINES CITY
Practice Address - State:FL
Practice Address - Zip Code:33844-7617
Practice Address - Country:US
Practice Address - Phone:863-877-2411
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MEDICAL ASSOCIATES OF CENTRAL FLORIDA PHYSICIANS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-20
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty