Basic Information
| Provider Information | |||||||||
| NPI: | 1699192443 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FLORIDA UROLOGY GROUP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 226 W MICHIGAN ST | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328064446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078391155 | ||||||||
| FaxNumber: | 4078390393 | ||||||||
| Practice Location | |||||||||
| Address1: | 226 W MICHIGAN ST | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328064446 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078391155 | ||||||||
| FaxNumber: | 4078390393 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2014 | ||||||||
| LastUpdateDate: | 03/18/2014 | ||||||||
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| AuthorizedOfficialLastName: | HUNTER | ||||||||
| AuthorizedOfficialFirstName: | PATRICK | ||||||||
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| AuthorizedOfficialTitleorPosition: | MD | ||||||||
| AuthorizedOfficialTelephone: | 4078391155 | ||||||||
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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 | 174400000X | ME37113 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Specialist |
No ID Information.