Provider Demographics
NPI:1306878145
Name:UROLOGY CARE OF CENTRAL FLORIDA P A
Entity type:Organization
Organization Name:UROLOGY CARE OF CENTRAL FLORIDA P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:D
Authorized Official - Last Name:JO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-351-0029
Mailing Address - Street 1:2301 SE 3RD AVE
Mailing Address - Street 2:BUILDING 100 SUITE A
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-5114
Mailing Address - Country:US
Mailing Address - Phone:352-351-0029
Mailing Address - Fax:352-840-9977
Practice Address - Street 1:2301 SE 3RD AVE
Practice Address - Street 2:BUILDING 100 SUITE A
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5114
Practice Address - Country:US
Practice Address - Phone:352-351-0029
Practice Address - Fax:352-840-9977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72987174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK8031Medicare ID - Type Unspecified
FLF92113Medicare UPIN