Provider Demographics
NPI:1982919056
Name:FLORIDA UROLOGY GROUP PA
Entity Type:Organization
Organization Name:FLORIDA UROLOGY GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICK
Authorized Official - Middle Name:T
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:407-839-1155
Mailing Address - Street 1:2690 ORANGE PEEL COURT
Mailing Address - Street 2:LEE B. CECIL
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806
Mailing Address - Country:US
Mailing Address - Phone:407-896-3055
Mailing Address - Fax:407-826-1103
Practice Address - Street 1:226 W MICHIGAN ST
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-4446
Practice Address - Country:US
Practice Address - Phone:407-839-1155
Practice Address - Fax:407-839-0393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-13
Last Update Date:2011-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD58902Medicare UPIN
FLDM940AMedicare PIN