Provider Demographics
NPI:1124097266
Name:SANCHEZ, PHILLIP LAWRENCE (MD)
Entity type:Individual
Prefix:
First Name:PHILLIP
Middle Name:LAWRENCE
Last Name:SANCHEZ
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 1:650 N WYMORE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2859
Mailing Address - Country:US
Mailing Address - Phone:407-644-9002
Mailing Address - Fax:407-644-9004
Practice Address - Street 1:650 N WYMORE RD
Practice Address - Street 2:SUITE 102
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2859
Practice Address - Country:US
Practice Address - Phone:407-644-9002
Practice Address - Fax:407-644-9004
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2012-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME30833207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL061930200Medicaid
FL59998XMedicare PIN
FL061930200Medicaid