Basic Information
| Provider Information | |||||||||
| NPI: | 1023567229 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORLANDO PHYSICIAN SPECIALISTS LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1561 W FAIRBANKS AVE | ||||||||
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| City: | WINTER PARK | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327894678 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073327700 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2250 BEDFORD RD | ||||||||
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| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328031443 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073037869 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/28/2016 | ||||||||
| LastUpdateDate: | 09/28/2016 | ||||||||
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| AuthorizedOfficialLastName: | WITTEN | ||||||||
| AuthorizedOfficialFirstName: | CHARLES | ||||||||
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| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4073037869 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208800000X | ME92559 | FL | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Urology |
No ID Information.