Basic Information
| Provider Information | |||||||||
| NPI: | 1790929073 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ADVENTIST HEALTH SYSTEMS SUNBELT INC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MEDICINE SPECIALISTS AT FLORIDA HOSPITAL | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2501 N. ORANGE AVE | ||||||||
| Address2: | SUITE 235 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073037270 | ||||||||
| FaxNumber: | 4073037285 | ||||||||
| Practice Location | |||||||||
| Address1: | 2501 N. ORANGE AVE | ||||||||
| Address2: | SUITE 235 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 32804 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4073037270 | ||||||||
| FaxNumber: | 4073037285 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/30/2009 | ||||||||
| LastUpdateDate: | 12/30/2015 | ||||||||
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| AuthorizedOfficialLastName: | TOL | ||||||||
| AuthorizedOfficialFirstName: | DARYL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT/CED | ||||||||
| AuthorizedOfficialTelephone: | 4073031531 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Dermatology | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.