Provider Demographics
NPI:1215164363
Name:OB GYN OF GREATER ORLANDO LLC
Entity type:Organization
Organization Name:OB GYN OF GREATER ORLANDO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:GEROME
Authorized Official - Middle Name:ALEX CLEEFORD
Authorized Official - Last Name:BELIARD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-846-4882
Mailing Address - Street 1:5308 S JOHN YOUNG PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-7362
Mailing Address - Country:US
Mailing Address - Phone:407-846-4882
Mailing Address - Fax:407-846-0416
Practice Address - Street 1:5308 S JOHN YOUNG PKWY STE 300
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-7362
Practice Address - Country:US
Practice Address - Phone:407-846-4882
Practice Address - Fax:407-355-3383
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL272868100Medicaid