Prime Radiology of Mount Dora, Inc

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

ME62144 Issued in FL

Legal business name

PRIME RADIOLOGY OF MOUNT DORA, INC

Practice address

6909 Old Highway 441 S
Mount Dora, FL 32757-7039

Phone

(321) 732-8487

Fax

(321) 348-5777

NPI assigned

Mar 27, 2015

Last updated

Mar 27, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Thomas Brown, MD

Title

Owner

Phone

(321) 732-8487

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1427414400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427414400000",
    "number": "1780078667",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6909 OLD HIGHWAY 441 S",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327577039",
            "telephone_number": "321-732-8487",
            "fax_number": "321-348-5777"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6909 OLD HIGHWAY 441 S",
            "city": "MOUNT DORA",
            "state": "FL",
            "postal_code": "327577039",
            "telephone_number": "321-732-8487",
            "fax_number": "321-348-5777"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PRIME RADIOLOGY OF MOUNT DORA, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-03-27",
        "last_updated": "2015-03-27",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "321-732-8487",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "FL",
            "license": "ME62144",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Diagnostic Radiology Physician in Mount Dora, FL
• Providers in Mount Dora, FL by specialty
• Diagnostic Radiology Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2015; 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.