Individual
DR. ORLANDO JOSE ICAZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
732 N 3RD ST, LEESBURG, FL 34748-4442
(352) 265-8356
(352) 787-0854
Mailing address
PO BOX 100275, GAINESVILLE, FL 32610-0275
(352) 273-7839
(352) 273-8172
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
ME66190
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
267636200
—
FL
01
—
71176
BCBS
FL
01
—
P00208162
RAILROAD MEDICARE
—
Enumeration date
07/15/2005
Last updated
02/23/2022
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