Individual
TEODORO MEDINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
111 WEBB DR, DAVENPORT, FL 33837-3962
(863) 421-9447
(863) 421-1806
Mailing address
6675 WESTWOOD BLVD, STE 475, ORLANDO, FL 32821
(407) 845-0330
(888) 972-1752
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
14489
PR
208D00000X
General Practice Physician
Primary
ACN 793
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
TW49T
FL BLUE
FL
Enumeration date
01/30/2007
Last updated
12/08/2017
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