Provider Demographics
NPI:1124052352
Name:ARCHINIHU, JOHNSPENCER C (MD)
Entity type:Individual
Prefix:DR
First Name:JOHNSPENCER
Middle Name:C
Last Name:ARCHINIHU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 SEMORAN BLVD.
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32807
Mailing Address - Country:US
Mailing Address - Phone:407-283-4014
Mailing Address - Fax:407-601-5988
Practice Address - Street 1:601 SEMORAN BLVD.
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32807
Practice Address - Country:US
Practice Address - Phone:407-283-4014
Practice Address - Fax:407-601-5988
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2012-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME68139207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL279671600Medicaid
FL28956ZMedicare PIN