# ORTHOPAEDIC CLINIC OF DAYTONA BEACH PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1073068458
- **Authorized official:** ALBERT W GILLESPY MD (PRESIDENT)
- **Authorized official phone:** (386) 255-4596

## Contact information

- **Practice address:** 1890 LPGA BOULEVARD, SUITE 240, DAYTONA BEACH, FL 32117-7131
- **Practice address phone:** (386) 255-4596
- **Practice address fax:** (386) 258-3561
- **Mailing address:** 1865 LPGA BLVD, DAYTONA BEACH, FL 32117-7108
- **Mailing address phone:** (386) 255-4596
- **Mailing address fax:** (386) 258-3561

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207X00000X | Orthopaedic Surgery Physician | — | FL | — |
| 332B00000X | Durable Medical Equipment & Medical Supplies | — | FL | Yes |

## Other

- **Enumeration date:** 08/16/2016
- **Last updated:** 08/02/2024