Provider Demographics
NPI:1215090691
Name:CENTER FOR REPRODUCTIVE MEDICINE
Entity type:Organization
Organization Name:CENTER FOR REPRODUCTIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY-TREASURER
Authorized Official - Prefix:
Authorized Official - First Name:RANDALL
Authorized Official - Middle Name:
Authorized Official - Last Name:LOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-740-0909
Mailing Address - Street 1:3435 PINEHURST AVE
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-4049
Mailing Address - Country:US
Mailing Address - Phone:407-740-0909
Mailing Address - Fax:407-740-5727
Practice Address - Street 1:3435 PINEHURST AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-4049
Practice Address - Country:US
Practice Address - Phone:407-740-0909
Practice Address - Fax:407-740-5727
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty