Family Tree Medical Group II, PA

Primary specialty

General Practice PhysicianTaxonomy code 208D00000X

Legal business name

FAMILY TREE MEDICAL GROUP II, PA

Practice address

2201 North Blvd W
Davenport, FL 33837-8990

Phone

(863) 353-1246

Fax

(863) 419-9547

NPI assigned

May 31, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Victor M Pantoja Jr.

Title

Buisness Owner

Phone

(407) 970-2981

Specialties & licenses 2

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1653955200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1670976000000",
    "number": "1720727654",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2201 NORTH BLVD W",
            "city": "DAVENPORT",
            "state": "FL",
            "postal_code": "338378990",
            "telephone_number": "863-353-1246",
            "fax_number": "863-419-9547"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2201 NORTH BLVD W",
            "city": "DAVENPORT",
            "state": "FL",
            "postal_code": "338378990",
            "telephone_number": "863-353-1246",
            "fax_number": "863-419-9547"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY TREE MEDICAL GROUP II, PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-05-31",
        "last_updated": "2022-12-14",
        "certification_date": "2022-12-14",
        "status": "A",
        "authorized_official_last_name": "PANTOJA",
        "authorized_official_first_name": "VICTOR",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "BUISNESS OWNER",
        "authorized_official_telephone_number": "407-970-2981",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr."
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "208D00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.