Florida Internal Medicine PA

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

Legal business name

FLORIDA INTERNAL MEDICINE PA

Practice address

4106 W Lake Mary Blvd
Suite 301
Lake Mary, FL 32746-3315

Phone

(407) 333-2503

Fax

(407) 333-0962

NPI assigned

Jun 2, 2006

Last updated

Aug 23, 2007By 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

Dr. Glen F Davis, MDNPI 1689617813

Title

President

Phone

(407) 333-2503

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in FL

Enrollment records 1

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Locations

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Glen F. Davis, M.D.

  • Internal Medicine Physician
  • Lake Mary, FL
  • NPI 1689617813
  Medicare reassignment NPD Authorized official
• Nicole Rodriguez, NURSE PRACTITIONER

  • Nurse Practitioner
  • Lake Mary, FL
  • NPI 1609346378
  Medicare reassignment Care Compare group NPD
• John F Ryan, M.D.

  • Internal Medicine Physician
  • Lake Mary, FL
  • NPI 1144266974
  Medicare reassignment Care Compare group NPD
• Elizabeth P Heil, M.D.

  • Internal Medicine Physician
  • Longwood, FL
  • NPI 1891738407
  NPD (past)

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

{
    "created_epoch": "1149206400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187827200000",
    "number": "1831136274",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4106 W LAKE MARY BLVD",
            "address_2": "SUITE 301",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327463315",
            "telephone_number": "407-333-2503",
            "fax_number": "407-333-0962"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4106 W LAKE MARY BLVD",
            "address_2": "SUITE 301",
            "city": "LAKE MARY",
            "state": "FL",
            "postal_code": "327463315",
            "telephone_number": "407-333-2503",
            "fax_number": "407-333-0962"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FLORIDA INTERNAL MEDICINE PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-02",
        "last_updated": "2007-08-23",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "GLEN",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "407-333-2503",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Internal Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Florida Eye Clinic P a
• Florida Foot & Ankle Group PA
• Florida Foot & Ankle Group PA
• Florida Health Care Plan Inc
• Florida Hospital Medical Group Inc (Rothman Orthopaedics AdventHealth Medical Group at Lake Mary)
• Florida Medical Orthopedic and Spine Institute
• Florida Neurology PA
• Florida Orthopaedic Associates PA
• Florida Pain & Rehabilitation Institute Inc
• Florida Pain & Rehabilitation Institute Inc (National Pain Institute)

• Internal Medicine Physician in Lake Mary, FL
• Providers in Lake Mary, FL by specialty
• Internal Medicine Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.