Provider Demographics
NPI:1124451471
Name:MID FLORIDA ENDOCRINE
Entity type:Organization
Organization Name:MID FLORIDA ENDOCRINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-614-1644
Mailing Address - Street 1:213 S DILLARD ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:WINTER GARDEN
Mailing Address - State:FL
Mailing Address - Zip Code:34787-3522
Mailing Address - Country:US
Mailing Address - Phone:407-614-1644
Mailing Address - Fax:407-614-1635
Practice Address - Street 1:213 S DILLARD ST
Practice Address - Street 2:SUITE 240
Practice Address - City:WINTER GARDEN
Practice Address - State:FL
Practice Address - Zip Code:34787-3522
Practice Address - Country:US
Practice Address - Phone:407-614-1644
Practice Address - Fax:407-614-1635
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-09
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHO125AMedicare PIN