Basic Information
| Provider Information | |||||||||
| NPI: | 1457300998 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ANESTHESIOLOGISTS OF GREATER ORLANDO INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 744536 | ||||||||
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| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303744536 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1053 MEDICAL CENTER DR | ||||||||
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| City: | ORANGE CITY | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327638260 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548382371 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/10/2006 | ||||||||
| LastUpdateDate: | 09/24/2019 | ||||||||
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| AuthorizedOfficialLastName: | DROZDOW | ||||||||
| AuthorizedOfficialFirstName: | GILBERT | ||||||||
| AuthorizedOfficialMiddleName: | L. | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF CLINICAL OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9548382371 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 367500000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered | 207L00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
ID Information
| ID | Type | State | Issuer | Description | 004459504 | 05 | FL | MEDICAID | 004459801 | 05 | FL | MEDICAID | 004459800 | 05 | FL | MEDICAID |