Provider Demographics
NPI:1487162632
Name:PEDIATRICS AND FAMILY CARE LLC
Entity type:Organization
Organization Name:PEDIATRICS AND FAMILY CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARILIZ
Authorized Official - Middle Name:BORBON
Authorized Official - Last Name:BUMGARNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-600-9389
Mailing Address - Street 1:5150 CURRY FORD RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-8744
Mailing Address - Country:US
Mailing Address - Phone:239-600-9389
Mailing Address - Fax:407-286-4739
Practice Address - Street 1:5150 CURRY FORD RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32812-8744
Practice Address - Country:US
Practice Address - Phone:407-286-3653
Practice Address - Fax:407-286-4739
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-22
Last Update Date:2025-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X
FLME91688208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL271218100Medicaid
FL7VFHMOtherBCBSFL