Basic Information
| Provider Information | |||||||||
| NPI: | 1861437451 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED GYNECOLOGY OF CENTRAL FLORIDA P A | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2501 N ORANGE AVE | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328044603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078989804 | ||||||||
| FaxNumber: | 4078989805 | ||||||||
| Practice Location | |||||||||
| Address1: | 2501 N ORANGE AVE | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | ORLANDO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 328044603 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078989804 | ||||||||
| FaxNumber: | 4078989805 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/18/2006 | ||||||||
| LastUpdateDate: | 12/27/2007 | ||||||||
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| AuthorizedOfficialLastName: | MERCER | ||||||||
| AuthorizedOfficialFirstName: | LANE | ||||||||
| AuthorizedOfficialMiddleName: | JAY | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 4078989804 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VG0400X | ME89606 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecology |
No ID Information.