Organization
FAMILY TREE MEDICAL GROUP, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. VICTOR MANUEL PANTOJA JR. CEO (CEO)
(407) 483-3200
Entity
Organization
Contact information
Practice address
1150 CYPRESS GLEN CIR, KISSIMMEE, FL 34741-7560
(407) 483-3200
(407) 483-3220
Mailing address
1150 CYPRESS GLEN CIR, KISSIMMEE, FL 34741-7560
(407) 483-3200
(407) 483-3220
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
—
208D00000X
General Practice Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017306100
—
FL
01
—
IV484A
MEDICARE
FL
Enumeration date
08/21/2015
Last updated
10/28/2024
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