Individual
MR. IVAN R REPASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
701 PLATINUM PT, LAKE MARY, FL 32746-4871
(407) 206-4500
(407) 829-2563
Mailing address
1285 ORANGE AVE, WINTER PARK, FL 32789-4949
(407) 647-2287
(407) 643-1300
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA1668
FL
363AM0700X
Medical Physician Assistant
PA1668
FL
363AS0400X
Surgical Physician Assistant
PA1668
FL
Other
Enumeration date
08/17/2006
Last updated
03/06/2012
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