Basic Information
| Provider Information | |||||||||
| NPI: | 1861146201 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ORLANDO FAMILY PHYSICIANS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6900 TAVISTOCK LAKES BLVD STE 300 | ||||||||
| Address2: | |||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328277592 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3213326947 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8408 N GRADY AVE | ||||||||
| Address2: | |||||||||
| City: | TAMPA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 336141907 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8138859091 | ||||||||
| FaxNumber: | 8133241133 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/04/2022 | ||||||||
| LastUpdateDate: | 02/04/2022 | ||||||||
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| AuthorizedOfficialLastName: | CYR | ||||||||
| AuthorizedOfficialFirstName: | SABENA | ||||||||
| AuthorizedOfficialMiddleName: | I | ||||||||
| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 3213326947 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | ORLANDO FAMILY PHYSICIANS, LLC | ||||||||
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| NPICertificationDate: | 02/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.