Organization
CENTRAL FLORIDA IMAGING ASSOCIATES, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. ELLIS B. NORSOPH MD (PRESIDENT/CEO)
(813) 899-6220
Entity
Organization
Contact information
Practice address
410 11TH STREET, LAKE WALES, FL 33853-4203
(863) 678-2761
(813) 985-8006
Mailing address
PO BOX 23027, TAMPA, FL 33623-3027
(813) 899-6220
(813) 985-8006
Taxonomy
Speciality
Code
Description
License number
State
2085B0100X
Body Imaging Physician
—
—
2085N0700X
Neuroradiology Physician
—
—
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
2085R0204X
Vascular & Interventional Radiology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001844600
—
FL
01
—
4007
STATE LICENSE NUMBER
FL
Enumeration date
01/04/2010
Last updated
03/26/2015
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